Healthcare Provider Details

I. General information

NPI: 1861093833
Provider Name (Legal Business Name): JOSEPH A EKHOFF
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2020
Last Update Date: 11/05/2020
Certification Date: 11/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10585 MOUNTAIN VISTA RDG
HIGHLANDS RANCH CO
80126-5586
US

IV. Provider business mailing address

1491 BERGEN ROCK ST
CASTLE ROCK CO
80109-3301
US

V. Phone/Fax

Practice location:
  • Phone: 303-387-1500
  • Fax:
Mailing address:
  • Phone: 815-953-9959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License NumberAT.0001061
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: