Healthcare Provider Details

I. General information

NPI: 1508846908
Provider Name (Legal Business Name): ROBERT M MACAULAY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 07/19/2022
Certification Date: 07/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1906 BLAKE AVE
GLENWOOD SPGS CO
81601-4227
US

IV. Provider business mailing address

PO BOX 2725
GLENWOOD SPGS CO
81602-2725
US

V. Phone/Fax

Practice location:
  • Phone: 970-945-6535
  • Fax:
Mailing address:
  • Phone: 970-945-1443
  • Fax: 970-947-9410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number35978
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: