Healthcare Provider Details

I. General information

NPI: 1083760680
Provider Name (Legal Business Name): AUDREY PRISCA DUMAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AUDREY DUMAS MD

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 05/13/2024
Certification Date: 05/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 BANNOCK ST # A
DENVER CO
80204-4507
US

IV. Provider business mailing address

777 BANNOCK ST # A
DENVER CO
80204-4597
US

V. Phone/Fax

Practice location:
  • Phone: 303-602-7221
  • Fax:
Mailing address:
  • Phone: 303-602-7221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number46309
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number46309
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number46309
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: