Provider Demographics
NPI:1477501831
Name:WICK, JAMES EUGENE (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:EUGENE
Last Name:WICK
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 1:1550 SOUTH POTOMAC STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-5431
Mailing Address - Country:US
Mailing Address - Phone:303-671-0953
Mailing Address - Fax:303-751-5424
Practice Address - Street 1:1550 SOUTH POTOMAC STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-5431
Practice Address - Country:US
Practice Address - Phone:303-671-0953
Practice Address - Fax:303-751-5424
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO21114207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04007209Medicaid
D23882Medicare UPIN
95851Medicare ID - Type Unspecified