Healthcare Provider Details

I. General information

NPI: 1144205303
Provider Name (Legal Business Name): ROBERT VINCENT NOUHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 04/23/2020
Certification Date: 04/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 W MOUNTAIN VIEW AVE
LONGMONT CO
80501-3128
US

IV. Provider business mailing address

1925 W MOUNTAIN VIEW AVE
LONGMONT CO
80501-3128
US

V. Phone/Fax

Practice location:
  • Phone: 303-833-8880
  • Fax: 303-682-8007
Mailing address:
  • Phone: 303-833-8880
  • Fax: 303-682-8007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR.0038248
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: