Provider Demographics
NPI:1235994104
Name:RAREDISEASEDOC
Entity Type:Organization
Organization Name:RAREDISEASEDOC
Other - Org Name:RAREDISEASEDOC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:BULBIN
Authorized Official - Last Name:DUIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-379-2275
Mailing Address - Street 1:28013 E NOVA PL
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-7437
Mailing Address - Country:US
Mailing Address - Phone:301-379-2275
Mailing Address - Fax:720-580-5613
Practice Address - Street 1:28013 E NOVA PL
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-7437
Practice Address - Country:US
Practice Address - Phone:301-379-2275
Practice Address - Fax:720-580-5613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-19
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)Group - Multi-Specialty
No207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No261QG0250XAmbulatory Health Care FacilitiesClinic/CenterGeneticsGroup - Multi-Specialty