Provider Demographics
NPI:1275739864
Name:MARGOLIS, ALAN JAY (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:JAY
Last Name:MARGOLIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10999 RIDGEGATE PARKWAY
Mailing Address - Street 2:STE 365
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124
Mailing Address - Country:US
Mailing Address - Phone:303-797-1150
Mailing Address - Fax:303-797-1150
Practice Address - Street 1:10999 RIDGE GATE PARKWAY
Practice Address - Street 2:STE 365
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124
Practice Address - Country:US
Practice Address - Phone:303-797-1150
Practice Address - Fax:303-797-1150
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO30863174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1308634Medicaid
COCOAAA1917Medicare PIN