Provider Demographics
NPI:1235115254
Name:DREISBACH, JAMES N (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:N
Last Name:DREISBACH
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 1:10700 E GEDDES AVE
Mailing Address - Street 2:NO 200
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3800
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:501 E HAMPDEN AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2702
Practice Address - Country:US
Practice Address - Phone:303-761-9190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO201482085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02249241OtherNY MEDICAID
TX053213701OtherTX MEDICAID
KY64049026OtherKY MEDICAID
IN200364610OtherIN MEDICAID
MI104686089OtherMI MEDICAID
NE10025709000Medicaid
WY117172100OtherWY MEDICAID
MT1235115254Medicaid
AZ424458OtherAZ MEDICAID
NECO305739OtherMEDICARE TRAILBAZER RIN
KS200417090AOtherKS MEDICAID
NE84-059792913Medicaid
CO940000060OtherRR MCRE RIA
CO940000105OtherRR MCRE MIC
CAXPY203373OtherCA MEDICAID
CO01201482Medicaid
NM18155235OtherNM MEDICAID
NENA1214051Medicare PIN
COCW4088Medicare PIN
NY02249241OtherNY MEDICAID
AZ424458OtherAZ MEDICAID
TX053213701OtherTX MEDICAID
NE84-059792913Medicaid
COC211948Medicare PIN
KS130702Medicare PIN
NEP00796324Medicare PIN