Healthcare Provider Details

I. General information

NPI: 1356734701
Provider Name (Legal Business Name): WILLIAM QUTUB
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2015
Last Update Date: 03/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6895 E HAMPDEN AVE
DENVER CO
80224-3047
US

IV. Provider business mailing address

PO BOX 271388
LITTLETON CO
80127-0023
US

V. Phone/Fax

Practice location:
  • Phone: 303-246-9879
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberDR.0045106
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: