Provider Demographics
NPI:1225000508
Name:ANNEBERG, AUGUST LEE (MD)
Entity Type:Individual
Prefix:
First Name:AUGUST
Middle Name:LEE
Last Name:ANNEBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 GILPIN ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-4012
Mailing Address - Country:US
Mailing Address - Phone:303-877-6219
Mailing Address - Fax:303-733-2560
Practice Address - Street 1:110 GILPIN ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-4012
Practice Address - Country:US
Practice Address - Phone:303-877-6219
Practice Address - Fax:303-733-2560
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO21331207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01213313Medicaid
3921Medicare ID - Type Unspecified
CO01213313Medicaid