Healthcare Provider Details

I. General information

NPI: 1922005610
Provider Name (Legal Business Name): WILLIAM G SELF JR MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8403 BRYANT ST
WESTMINSTER CO
80031-3809
US

IV. Provider business mailing address

8403 BRYANT ST
WESTMINSTER CO
80031-3809
US

V. Phone/Fax

Practice location:
  • Phone: 303-426-4810
  • Fax: 303-426-8708
Mailing address:
  • Phone: 303-426-4810
  • Fax: 303-426-8708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAMES E MONTGOMERY
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 303-426-4810