Provider Demographics
NPI:1174506695
Name:ALLERGY & ASTHMA CONSULTANTS OF THE ROCKIES PC
Entity Type:Organization
Organization Name:ALLERGY & ASTHMA CONSULTANTS OF THE ROCKIES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-761-4343
Mailing Address - Street 1:3601 S CLARKSON
Mailing Address - Street 2:STE 200
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-3946
Mailing Address - Country:US
Mailing Address - Phone:303-761-4343
Mailing Address - Fax:303-761-0943
Practice Address - Street 1:3601 S CLARKSON
Practice Address - Street 2:STE 200
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-3946
Practice Address - Country:US
Practice Address - Phone:303-761-4343
Practice Address - Fax:303-761-0943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-29
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCF7708Medicare UPIN
COCF7708Medicare PIN