Healthcare Provider Details

I. General information

NPI: 1053381053
Provider Name (Legal Business Name): RICHARD CHARLES DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 05/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 UNIVERSITY BLVD SUITE 204
DENVER CO
80206-4657
US

IV. Provider business mailing address

2961 ALTON CT SUITE 204
DENVER CO
80238-2896
US

V. Phone/Fax

Practice location:
  • Phone: 303-355-1695
  • Fax: 303-355-1834
Mailing address:
  • Phone: 720-530-1122
  • Fax: 866-771-0081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number345
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: