Provider Demographics
NPI:1316189152
Name:DENNIS M. WEISBROD M.D., P.C.
Entity Type:Organization
Organization Name:DENNIS M. WEISBROD M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:MAURICE
Authorized Official - Last Name:WEISBROD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-931-9344
Mailing Address - Street 1:1601 E 19TH AVE
Mailing Address - Street 2:SUITE 4200
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1216
Mailing Address - Country:US
Mailing Address - Phone:303-831-8344
Mailing Address - Fax:303-861-8615
Practice Address - Street 1:1601 E 19TH AVE
Practice Address - Street 2:SUITE 4200
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1216
Practice Address - Country:US
Practice Address - Phone:303-831-8344
Practice Address - Fax:303-861-8615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-25
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO17058207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO119478225Medicaid
CO04760088Medicaid
CO119478225Medicaid
COCOB4588Medicare PIN
CO04760088Medicaid