Healthcare Provider Details

I. General information

NPI: 1114077534
Provider Name (Legal Business Name): DONALD W BECHTOLD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 11/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4851 INDEPENDENCE ST 70 EXECUTIVE CENTER, SUITE 200
WHEAT RIDGE CO
80033-6715
US

IV. Provider business mailing address

1735 ALKIRE ST
GOLDEN CO
80401-3521
US

V. Phone/Fax

Practice location:
  • Phone: 303-432-5169
  • Fax: 303-432-5036
Mailing address:
  • Phone: 303-237-4513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number24336
License Number StateCO

VII. Legacy identifiers

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

# 1
Identifier04530085
Identifier TypeMEDICAID
Identifier StateCO
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: