Provider Demographics
NPI:1033430400
Name:SOUTH DENVER ENDOCRINOLOGY, PC
Entity Type:Organization
Organization Name:SOUTH DENVER ENDOCRINOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:SHARI
Authorized Official - Middle Name:C
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-465-3173
Mailing Address - Street 1:8200 E BELLEVIEW AVE
Mailing Address - Street 2:SUITE 200-C
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2803
Mailing Address - Country:US
Mailing Address - Phone:720-381-3344
Mailing Address - Fax:866-926-6850
Practice Address - Street 1:8200 E BELLEVIEW AVE
Practice Address - Street 2:SUITE 200-C
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2803
Practice Address - Country:US
Practice Address - Phone:720-381-3344
Practice Address - Fax:866-926-6850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-18
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO47445207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO42434572Medicaid
TX166856801Medicaid
TX8B9087Medicare PIN
COCO304881Medicare PIN
CO42434572Medicaid
GAP00150351Medicare PIN