Healthcare Provider Details

I. General information

NPI: 1174506695
Provider Name (Legal Business Name): ALLERGY & ASTHMA CONSULTANTS OF THE ROCKIES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 01/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 S CLARKSON STE 200
ENGLEWOOD CO
80113-3946
US

IV. Provider business mailing address

3601 S CLARKSON STE 200
ENGLEWOOD CO
80113-3946
US

V. Phone/Fax

Practice location:
  • Phone: 303-761-4343
  • Fax: 303-761-0943
Mailing address:
  • Phone: 303-761-4343
  • Fax: 303-761-0943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID L GOODMAN
Title or Position: OWNER
Credential: MD
Phone: 303-761-4343