Healthcare Provider Details

I. General information

NPI: 1316999469
Provider Name (Legal Business Name): STEPHEN WILLIAM SUBBER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 CLERMONT ST BOX 114
DENVER CO
80220-3808
US

IV. Provider business mailing address

PO BOX 6914
DENVER CO
80206-0914
US

V. Phone/Fax

Practice location:
  • Phone: 303-399-8020
  • Fax: 303-393-5195
Mailing address:
  • Phone: 303-399-8020
  • Fax: 303-393-5195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number25821
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: