Healthcare Provider Details

I. General information

NPI: 1376718403
Provider Name (Legal Business Name): COLLEEN M MCGUIRE D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DR. COLLEEN MEDEARIS MCGUIRE

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 06/14/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6507 S SANTA FE DR
LITTLETON CO
80120-2910
US

IV. Provider business mailing address

777 BANNOCK ST
DENVER CO
80204-4507
US

V. Phone/Fax

Practice location:
  • Phone: 303-730-8858
  • Fax:
Mailing address:
  • Phone: 303-602-7221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0102207948
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number49982
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: