Healthcare Provider Details

I. General information

NPI: 1518007657
Provider Name (Legal Business Name): PEDIATRICS AT LOWRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 RAMPART WAY STE 220
DENVER CO
80230-6429
US

IV. Provider business mailing address

125 RAMPART WAY STE 220
DENVER CO
80230-6429
US

V. Phone/Fax

Practice location:
  • Phone: 720-859-8222
  • Fax:
Mailing address:
  • Phone: 720-859-8222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number17427
License Number StateCO

VIII. Authorized Official

Name: PAUL BOGAN
Title or Position: MD
Credential: MD
Phone: 720-859-8222