Healthcare Provider Details

I. General information

NPI: 1518184399
Provider Name (Legal Business Name): ASSOCIATES OF OTOLARYNGOLOGY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 06/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 E HARVARD AVE STE # 505
DENVER CO
80210-5073
US

IV. Provider business mailing address

850 E HARVARD AVE STE # 505
DENVER CO
80210-5073
US

V. Phone/Fax

Practice location:
  • Phone: 303-744-1961
  • Fax: 303-744-1110
Mailing address:
  • Phone: 303-744-1961
  • Fax: 303-744-1110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. VINCE MOCK
Title or Position: CEO
Credential:
Phone: 303-744-1961