Provider Demographics
NPI:1366453516
Name:PACKER, ROBERT H (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:H
Last Name:PACKER
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 1:1551 MILKY WAY
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80260-4713
Mailing Address - Country:US
Mailing Address - Phone:303-426-4525
Mailing Address - Fax:303-428-6381
Practice Address - Street 1:8550 W 38TH AVE
Practice Address - Street 2:STE 108
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033
Practice Address - Country:US
Practice Address - Phone:303-426-4525
Practice Address - Fax:303-421-2121
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO25926207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01259266Medicaid
CO003417OtherKAISER COMMERCIAL NUMBER
AP1411470OtherDEA
A35076Medicare UPIN
CO01259266Medicaid
COCB8698Medicare PIN
AP1411470OtherDEA