Healthcare Provider Details

I. General information

NPI: 1366678542
Provider Name (Legal Business Name): PAUL DANIEL LOBITZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2009
Last Update Date: 03/26/2020
Certification Date: 03/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 W 16TH ST
GREELEY CO
80634-4941
US

IV. Provider business mailing address

6801 W 20TH ST SUITE 101, ATTN:SUE,CREDENTIALING
GREELEY CO
80634-9637
US

V. Phone/Fax

Practice location:
  • Phone: 970-356-2520
  • Fax: 970-356-6928
Mailing address:
  • Phone: 970-378-8000
  • Fax: 970-378-8088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberTL-3264
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR.0049269
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: