Provider Demographics
NPI:1487640462
Name:WOLVERTON, DULCY E (MD)
Entity Type:Individual
Prefix:DR
First Name:DULCY
Middle Name:E
Last Name:WOLVERTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10700 E. GEDDES AVE
Mailing Address - Street 2:ATTN: CREDENTIALING
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3681
Mailing Address - Country:US
Mailing Address - Phone:303-761-9190
Mailing Address - Fax:303-761-6278
Practice Address - Street 1:10700 E. GEDDES AVE
Practice Address - Street 2:ATTN: CREDENTIALING
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-3681
Practice Address - Country:US
Practice Address - Phone:303-761-9190
Practice Address - Fax:303-761-6278
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG738342085R0202X
CO463022085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1487640462Medicaid
CA1487640462Medicaid
CO55580033Medicaid
KS200875450AMedicaid
NM73428752Medicaid
MT1487640462Medicaid
NE84059792913Medicaid
CO55580033Medicaid
COF35733Medicare UPIN
NM73428752Medicaid
WY1487640462Medicaid
NE84059792913Medicaid