Healthcare Provider Details

I. General information

NPI: 1245282862
Provider Name (Legal Business Name): ROBERT Z MOGHIM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 10/20/2020
Certification Date: 10/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 HERITAGE RD SUITE 100
GOLDEN CO
80401-3600
US

IV. Provider business mailing address

755 HERITAGE RD STE 100
GOLDEN CO
80401-3600
US

V. Phone/Fax

Practice location:
  • Phone: 303-277-0700
  • Fax:
Mailing address:
  • Phone: 303-277-0700
  • Fax: 303-277-0714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberDR0039871
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: