Healthcare Provider Details

I. General information

NPI: 1831152685
Provider Name (Legal Business Name): TODD ZOLTAN MD, JD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 02/02/2024
Certification Date: 02/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

559 VINCENT ST. SPACE BASE DELTA 1
PETERSON SPACE FORCE BASE CO
80914
US

IV. Provider business mailing address

559 VINCENT ST. SPACE BASE DELTA 1
PETERSON SPACE FORCE BASE CO
80914
US

V. Phone/Fax

Practice location:
  • Phone: 303-415-7599
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR.0060167
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: