Healthcare Provider Details

I. General information

NPI: 1275769325
Provider Name (Legal Business Name): KATHERINE MARIE ZYBACH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE MARIE STURGEON MD

II. Dates (important events)

Enumeration Date: 06/03/2009
Last Update Date: 11/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2643 PATTERSON RD STE 603
GRAND JUNCTION CO
81506-1937
US

IV. Provider business mailing address

9224 TEDDY LN SUITE 200
LONE TREE CO
80124-6798
US

V. Phone/Fax

Practice location:
  • Phone: 970-298-7440
  • Fax:
Mailing address:
  • Phone: 303-790-1515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2012020840
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301094205
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDR0055909
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: