Provider Demographics
NPI:1467453787
Name:REICHMAN, OWEN STANLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:OWEN
Middle Name:STANLEY
Last Name:REICHMAN
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 1:4500 E 9TH AVE
Mailing Address - Street 2:SUITE 610
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-3900
Mailing Address - Country:US
Mailing Address - Phone:303-316-7048
Mailing Address - Fax:303-316-7061
Practice Address - Street 1:4500 E 9TH AVE
Practice Address - Street 2:SUITE 610
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-3900
Practice Address - Country:US
Practice Address - Phone:303-316-7048
Practice Address - Fax:303-316-7061
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO39047207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05253811Medicaid
CO05253811Medicaid
COC463278Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER