Healthcare Provider Details

I. General information

NPI: 1639174261
Provider Name (Legal Business Name): JEFF OWEN RICHKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 04/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 CAMPUS DR SUITE A
LAFAYETTE CO
80026-3357
US

IV. Provider business mailing address

500 ELDORADO BLVD SUITE 6250
BROOMFIELD CO
80021-3408
US

V. Phone/Fax

Practice location:
  • Phone: 303-665-1900
  • Fax: 303-926-1781
Mailing address:
  • Phone: 303-272-0751
  • Fax: 303-318-2488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35370
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier01353705
Identifier TypeMEDICAID
Identifier StateCO
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: