Provider Demographics
NPI:1548219934
Name:KOUYOUMDJIAN, GREGORY A (MD)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:A
Last Name:KOUYOUMDJIAN
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 1:8381 SOUTHPARK LN
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-4508
Mailing Address - Country:US
Mailing Address - Phone:303-991-9662
Mailing Address - Fax:
Practice Address - Street 1:8381 SOUTHPARK LN
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-4508
Practice Address - Country:US
Practice Address - Phone:303-991-9662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0064496207WX0009X
CO38767207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO465288Medicaid
BK6789715OtherDEA
H24233Medicare UPIN
BK6789715OtherDEA