Healthcare Provider Details

I. General information

NPI: 1245318419
Provider Name (Legal Business Name): NATHAN S PERSOFF, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 11/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E HAMPDEN AVE SUITE 350
ENGLEWOOD CO
80113-2736
US

IV. Provider business mailing address

701 E HAMPDEN AVE SUITE 350
ENGLEWOOD CO
80113-2736
US

V. Phone/Fax

Practice location:
  • Phone: 303-788-6490
  • Fax: 303-788-5451
Mailing address:
  • Phone: 303-788-6490
  • Fax: 303-788-5451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number37390
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number18924
License Number StateCO

VIII. Authorized Official

Name: DR. NATHAN S PERSOFF
Title or Position: PRESIDENT
Credential: MD
Phone: 303-788-6490