Healthcare Provider Details

I. General information

NPI: 1245255504
Provider Name (Legal Business Name): MICHAEL REID MAYO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 01/31/2022
Certification Date: 01/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8931 HURON ST
THORNTON CO
80260-6806
US

IV. Provider business mailing address

1870 W 122ND AVE STE 100
WESTMINSTER CO
80234-2075
US

V. Phone/Fax

Practice location:
  • Phone: 303-853-3500
  • Fax: 303-853-3702
Mailing address:
  • Phone: 303-853-3500
  • Fax: 303-853-3702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number31734
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberDR.0067952
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier111549000
Identifier TypeMEDICAID
Identifier StateFL
Identifier IssuerFlorida Medicaid Provider ID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: