Healthcare Provider Details

I. General information

NPI: 1912942038
Provider Name (Legal Business Name): DEREK ZUKOSKY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 01/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 INDIANA ST STE 300
GOLDEN CO
80401-5027
US

IV. Provider business mailing address

400 INDIANA ST STE 300
GOLDEN CO
80401-5027
US

V. Phone/Fax

Practice location:
  • Phone: 303-985-2550
  • Fax: 303-985-2586
Mailing address:
  • Phone: 303-985-2550
  • Fax: 303-985-2586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number42927
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: