Provider Demographics
NPI:1518007657
Name:PEDIATRICS AT LOWRY
Entity Type:Organization
Organization Name:PEDIATRICS AT LOWRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:BOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:720-859-8222
Mailing Address - Street 1:125 RAMPART WAY STE 220
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-6429
Mailing Address - Country:US
Mailing Address - Phone:720-859-8222
Mailing Address - Fax:
Practice Address - Street 1:125 RAMPART WAY STE 220
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80230-6429
Practice Address - Country:US
Practice Address - Phone:720-859-8222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO17427208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty