Healthcare Provider Details

I. General information

NPI: 1730343260
Provider Name (Legal Business Name): JONATHAN BURDICK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2008
Last Update Date: 09/23/2020
Certification Date: 09/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1960 N OGDEN ST STE 460
DENVER CO
80218-3670
US

IV. Provider business mailing address

7786 S SAULSBURY ST
LITTLETON CO
80128-5452
US

V. Phone/Fax

Practice location:
  • Phone: 303-318-2500
  • Fax:
Mailing address:
  • Phone: 720-981-0214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTL2908
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number48314
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: