Healthcare Provider Details

I. General information

NPI: 1396996195
Provider Name (Legal Business Name): JIAN-ZHE CAO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2008
Last Update Date: 01/27/2022
Certification Date: 01/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 E KEN PRATT BLVD FL 3
LONGMONT CO
80504-5311
US

IV. Provider business mailing address

1750 E KEN PRATT BLVD FL 3
LONGMONT CO
80504-5311
US

V. Phone/Fax

Practice location:
  • Phone: 720-718-3930
  • Fax: 720-718-0999
Mailing address:
  • Phone: 720-718-3930
  • Fax: 720-718-0999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberDR.0062560
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: