Provider Demographics
NPI:1275512931
Name:FILLMORE, JOSEPH H (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:H
Last Name:FILLMORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:7730 E BELLEVIEW AVE
Mailing Address - Street 2:STE A200
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2617
Mailing Address - Country:US
Mailing Address - Phone:303-792-2959
Mailing Address - Fax:303-792-2969
Practice Address - Street 1:5975 S QUEBEC ST
Practice Address - Street 2:SUITE 150
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-4564
Practice Address - Country:US
Practice Address - Phone:303-792-2959
Practice Address - Fax:303-792-2969
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO37051208VP0000X, 208100000X
IL036097759208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COH46194Medicare UPIN
ILH46194Medicare UPIN