Healthcare Provider Details

I. General information

NPI: 1992713069
Provider Name (Legal Business Name): SHARON IVONNE LANGENDOERFER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 05/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 BANNOCK ST MC 7782
DENVER CO
80204-4507
US

IV. Provider business mailing address

777 BANNOCK STREET M.C. #0590
DENVER CO
80204-4507
US

V. Phone/Fax

Practice location:
  • Phone: 303-436-6000
  • Fax:
Mailing address:
  • Phone: 303-602-9270
  • Fax: 303-602-9159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number16615
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: