Healthcare Provider Details

I. General information

NPI: 1003031055
Provider Name (Legal Business Name): COLORADO ORTHOPEDIC CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1980 E CHENANGO CT
ENGLEWOOD CO
80113-7126
US

IV. Provider business mailing address

1980 E CHENANGO CT
ENGLEWOOD CO
80113-7126
US

V. Phone/Fax

Practice location:
  • Phone: 303-777-3788
  • Fax: 303-940-7773
Mailing address:
  • Phone: 303-777-3788
  • Fax: 303-940-7773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: IRA STEPHEN DAVIS
Title or Position: OWNER
Credential: MD
Phone: 303-777-3788