Provider Demographics
NPI:1265038574
Name:SOUTH DENVER GASTROENTEROLOGY, PC
Entity Type:Organization
Organization Name:SOUTH DENVER GASTROENTEROLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-788-8888
Mailing Address - Street 1:9397 CROWN CREST BLVD STE 221
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-8576
Mailing Address - Country:US
Mailing Address - Phone:303-788-8888
Mailing Address - Fax:866-896-1158
Practice Address - Street 1:9397 CROWN CREST BLVD STE 221
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-8576
Practice Address - Country:US
Practice Address - Phone:303-788-8888
Practice Address - Fax:866-896-1158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-10
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty