Healthcare Provider Details

I. General information

NPI: 1215179049
Provider Name (Legal Business Name): ANN MARY JOSEPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2009
Last Update Date: 06/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 BANNOCK ST MC 3240
DENVER CO
80204-4507
US

IV. Provider business mailing address

777 BANNOCK ST MC 3240
DENVER CO
80204-4507
US

V. Phone/Fax

Practice location:
  • Phone: 303-602-2714
  • Fax: 303-602-2719
Mailing address:
  • Phone: 303-602-2714
  • Fax: 303-602-2719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number205603
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number55388
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: