Healthcare Provider Details

I. General information

NPI: 1093065245
Provider Name (Legal Business Name): PENELOPE H THRON-WEBER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2012
Last Update Date: 09/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1370 S WADSWORTH BLVD
LAKEWOOD CO
80232-5439
US

IV. Provider business mailing address

PO BOX 643
WHEAT RIDGE CO
80034-0643
US

V. Phone/Fax

Practice location:
  • Phone: 303-985-8773
  • Fax:
Mailing address:
  • Phone: 303-985-8773
  • Fax: 303-985-0827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number26213
License Number StateCO

VIII. Authorized Official

Name: PENELOPE H THRON-WEBER
Title or Position: OWNER
Credential: MD
Phone: 303-985-8773