MEDICARE: GARY TOUB, PH.D., INC.

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	103T00000X	Psychologist	635	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	TOT9672	OTHER	CO	ANTHEM BCBS PROVIDER ID

General Provider Information

NPI Number	:	1194752436
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARY TOUB, PH.D., INC.

Provider Business Mailing Address
First Line	:	1271 LAFAYETTE ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80218-2315
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1271 LAFAYETTE ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80218-2315
Country	:	US
Telephone Number	:	303-278-2448
Fax Number	:	303-394-4933

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GARY S. TOUB
Credential	:	PH.D.
Telephone Number	:	303-278-2448

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	05/23/2011

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