=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376955245
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAVID ARCHIBALD MD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/27/2014
-----------------------------------------------------
Last Update Date | 03/26/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2352 MEADOWS BLVD SUITE 290
-----------------------------------------------------
City | CASTLE ROCK
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80109-8406
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-268-2222
-----------------------------------------------------
Fax | 303-268-2223
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2352 MEADOWS BLVD SUITE 290
-----------------------------------------------------
City | CASTLE ROCK
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80109-8406
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-268-2222
-----------------------------------------------------
Fax | 303-268-2223
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. DAVID JONAS ARCHIBALD
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 509-315-6657
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207YX0905X
-----------------------------------------------------
Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
-----------------------------------------------------
License Number | DR.0053492
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------