MEDICARE: DR. GEORGE V. ROSSIE PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	799	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	M19989	OTHER	CO	STATE WORK COMP
2	186491300	OTHER	CO	OWCP
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184708497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE V. ROSSIE PH.D.

Provider Business Mailing Address
First Line	:	4200 W CONEJOS PL
Second Line	:	#111
City	:	DENVER
State	:	CO
Zip	:	80204-1333
Country	:	US
Telephone Number	:	303-893-9300
Fax Number	:	303-893-4384

Provider Business Practice Location Address
First Line	:	4200 W CONEJOS PL
Second Line	:	#111
City	:	DENVER
State	:	CO
Zip	:	80204-1333
Country	:	US
Telephone Number	:	303-893-9300
Fax Number	:	303-893-4384

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	07/08/2007

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