Provider Demographics
NPI:1255490801
Name:HAVLEN, PAMELA (MD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:
Last Name:HAVLEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 S MONACO ST
Mailing Address - Street 2:STE 210
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3486
Mailing Address - Country:US
Mailing Address - Phone:303-861-7001
Mailing Address - Fax:303-861-8624
Practice Address - Street 1:1601 E 19TH AVE
Practice Address - Street 2:#6000
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1216
Practice Address - Country:US
Practice Address - Phone:303-861-7001
Practice Address - Fax:303-861-8624
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3993207R00000X
CO52432207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO22580247Medicaid
TX152543801Medicaid
CO22580247Medicaid
COP01297795Medicare PIN
CO298301YL7XMedicare PIN
TX152543801Medicaid