Healthcare Provider Details

I. General information

NPI: 1073789160
Provider Name (Legal Business Name): RANDALL DOUGLAS BUZAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2008
Last Update Date: 05/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 S MADISON ST # 222
DENVER CO
80209-3011
US

IV. Provider business mailing address

155 S MADISON ST # 222
DENVER CO
80209-3011
US

V. Phone/Fax

Practice location:
  • Phone: 303-377-4956
  • Fax: 303-377-4965
Mailing address:
  • Phone: 303-377-4956
  • Fax: 303-377-4965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number29560
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: