Provider Demographics
NPI:1215179049
Name:JOSEPH, ANN MARY
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:MARY
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 BANNOCK ST
Mailing Address - Street 2:MC 3240
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-4507
Mailing Address - Country:US
Mailing Address - Phone:303-602-2714
Mailing Address - Fax:303-602-2719
Practice Address - Street 1:777 BANNOCK ST
Practice Address - Street 2:MC 3240
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-4507
Practice Address - Country:US
Practice Address - Phone:303-602-2714
Practice Address - Fax:303-602-2719
Is Sole Proprietor?:No
Enumeration Date:2009-03-25
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2056032084P0800X
CO553882084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1883271Medicaid
LA1883271Medicaid