Healthcare Provider Details

I. General information

NPI: 1508285776
Provider Name (Legal Business Name): COLORADO PAIN PRACTICE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 01/03/2022
Certification Date: 01/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12596 W BAYAUD AVE STE 350
LAKEWOOD CO
80228-2019
US

IV. Provider business mailing address

1355 SOUTH COLORADO BOULEVARD SUITE 700
DENVER CO
80222
US

V. Phone/Fax

Practice location:
  • Phone: 303-468-7246
  • Fax: 303-277-0714
Mailing address:
  • Phone: 303-282-1520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT MOGHIM
Title or Position: CEO
Credential:
Phone: 303-282-1520