Provider Demographics
NPI:1235269895
Name:ROCKY MOUNTAIN GYNECOLOGIC ONCOLOGY,P.C.
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN GYNECOLOGIC ONCOLOGY,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:P
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-781-9090
Mailing Address - Street 1:701 E HAMPDEN AVE
Mailing Address - Street 2:STE 210
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-2736
Mailing Address - Country:US
Mailing Address - Phone:303-781-9090
Mailing Address - Fax:
Practice Address - Street 1:701 E HAMPDEN AVE
Practice Address - Street 2:STE 210
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2736
Practice Address - Country:US
Practice Address - Phone:303-781-9090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01307362Medicaid
WY115941100Medicaid
MT000088045Medicaid
CO01307362Medicaid