Provider Demographics
NPI:1154846939
Name:COLORADO PAIN PRACTICE, PLLC
Entity Type:Organization
Organization Name:COLORADO PAIN PRACTICE, PLLC
Other - Org Name:COLORADO PAIN PRACTICE, PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MOGHIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-888-2219
Mailing Address - Street 1:1355 S COLORADO BLVD STE 700
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-3325
Mailing Address - Country:US
Mailing Address - Phone:303-963-9182
Mailing Address - Fax:
Practice Address - Street 1:2696 S COLORADO BLVD STE 100
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222
Practice Address - Country:US
Practice Address - Phone:303-963-9182
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty