Healthcare Provider Details

I. General information

NPI: 1508103961
Provider Name (Legal Business Name): ANDY M. FINE, M.D., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2013
Last Update Date: 11/17/2023
Certification Date: 11/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 W DRY CREEK CIR
LITTLETON CO
80120-4478
US

IV. Provider business mailing address

20 W DRY CREEK CIR
LITTLETON CO
80120-4478
US

V. Phone/Fax

Practice location:
  • Phone: 303-703-8583
  • Fax: 303-703-9791
Mailing address:
  • Phone: 303-703-8583
  • Fax: 303-703-9791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number34784
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number3227
License Number StateCO

VIII. Authorized Official

Name: OLGA M WEBBER
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 303-703-8583