Healthcare Provider Details

I. General information

NPI: 1164415691
Provider Name (Legal Business Name): DAVID R CONWAY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 11/23/2020
Certification Date: 11/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7780 S BROADWAY SUITE 100
LITTLETON CO
80122-2648
US

IV. Provider business mailing address

205 S GARRISON ST
LAKEWOOD CO
80226-2843
US

V. Phone/Fax

Practice location:
  • Phone: 303-798-9996
  • Fax: 303-730-1145
Mailing address:
  • Phone: 720-728-5170
  • Fax: 720-866-9967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number37704
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: