Provider Demographics
NPI:1326031386
Name:PERSOFF, NATHAN S (MD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:S
Last Name:PERSOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4900 S MONACO ST STE 210
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3487
Mailing Address - Country:US
Mailing Address - Phone:303-788-8355
Mailing Address - Fax:303-788-4448
Practice Address - Street 1:701 E HAMPDEN AVE
Practice Address - Street 2:SUITE 350
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2736
Practice Address - Country:US
Practice Address - Phone:303-788-8355
Practice Address - Fax:303-788-4448
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO18924207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01189240Medicaid
COC441358Medicare PIN
CO533453YL7XMedicare PIN
CO01189240Medicaid