Healthcare Provider Details

I. General information

NPI: 1659620060
Provider Name (Legal Business Name): PORTERCARE ADVENTIST HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2012
Last Update Date: 04/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9397 CROWN CREST BLVD SUITE 431
PARKER CO
80138-8575
US

IV. Provider business mailing address

PO BOX 911244
DENVER CO
80291-1244
US

V. Phone/Fax

Practice location:
  • Phone: 303-649-3115
  • Fax: 303-649-3116
Mailing address:
  • Phone: 303-643-1099
  • Fax: 303-643-1176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID L WATSON
Title or Position: C.M.O.
Credential: M.D.
Phone: 303-673-7181