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General NPI Number Information
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NPI Number | 1316333016
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Entity Type | Individual
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Provider Name | JONATHAN DATAR MD
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Gender | Male
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Dates
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Enumeration Date | 04/09/2015
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Last Update Date | 07/23/2020
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Provider Practice Location Address
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Address Line | 4700 HALE PKWY STE 340
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City | DENVER
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State | CO
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Zip | 80220-4024
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Country | US
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Telephone | 303-781-4485
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Fax | 720-274-0064
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Provider Business Mailing Address
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Address Line | PO BOX 17528
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City | DENVER
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State | CO
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Zip | 80217-0528
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Country | US
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Telephone | 405-681-3393
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Fax | 405-384-6793
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 036149619
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License Number State | IL
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