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General NPI Number Information
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NPI Number | 1700263183
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Entity Type | Organization
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Legal Business Name | JAN PAUL GOLDBERG
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Dates
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Enumeration Date | 05/05/2015
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Last Update Date | 05/05/2015
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Provider Practice Location Address
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Address Line | 816 ACOMA ST 1113
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City | DENVER
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State | CO
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Zip | 80204-4010
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Country | US
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Telephone | 303-912-4900
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Fax | 720-328-9367
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Provider Business Mailing Address
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Address Line | 816 ACOMA ST 1113
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City | DENVER
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State | CO
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Zip | 80204-4010
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Country | US
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Telephone | 303-912-4900
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Fax | 720-328-9367
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAN PAUL GOLDBERG
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Credential | MD
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Telephone | 303-912-4900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2800X
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Taxonomy Name | Methadone Clinic
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License Number | 21715
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License Number State | CO
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