Provider Demographics
NPI:1487648077
Name:NATHAN, ROBERT ALAN (MD)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:ALAN
Last Name:NATHAN
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 1:2709 N TEJON ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-6231
Mailing Address - Country:US
Mailing Address - Phone:719-473-0872
Mailing Address - Fax:719-630-3658
Practice Address - Street 1:2709 N TEJON ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-6231
Practice Address - Country:US
Practice Address - Phone:719-473-0872
Practice Address - Fax:719-630-3658
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO21249207RA0201X
FL25825207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01212497Medicaid
CO01212497Medicaid
AN7815511OtherDEA
CO01212497Medicaid