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General NPI Number Information
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NPI Number | 1578744017
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Entity Type | Organization
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Legal Business Name | DENVER NEUROLOGICAL CLINIC PROFESSIONAL LLC
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Dates
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Enumeration Date | 11/26/2007
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Last Update Date | 08/31/2023
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Provider Practice Location Address
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Address Line | 9980 PARK MEADOWS DR STE 100
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City | LONE TREE
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State | CO
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Zip | 80124-8404
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Country | US
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Telephone | 303-715-9024
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Fax | 303-715-7057
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Provider Business Mailing Address
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Address Line | 9980 PARK MEADOWS DR STE 100
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City | LONE TREE
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State | CO
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Zip | 80124-8404
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Country | US
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Telephone | 303-715-9024
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Fax | 303-715-7057
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. JUSTIN MOON
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Credential | MD
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Telephone | 303-715-9024
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0600X
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Taxonomy Name | Clinical Neurophysiology Physician
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License Number | 42593
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License Number State | CO
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