Provider Demographics
NPI:1326373770
Name:DAHL, JOHN HARRISON (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HARRISON
Last Name:DAHL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5 RANGEVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80215-6616
Mailing Address - Country:US
Mailing Address - Phone:303-233-6006
Mailing Address - Fax:303-233-0471
Practice Address - Street 1:5 RANGEVIEW CIR
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80215-6616
Practice Address - Country:US
Practice Address - Phone:303-233-6006
Practice Address - Fax:303-233-0471
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-02
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO13510207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0471Medicare PIN