Provider Demographics
NPI:1548397516
Name:PALEN, THEODORE EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:EDWARD
Last Name:PALEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:TED
Other - Middle Name:E
Other - Last Name:PALEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:10350 E DAKOTA AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-1314
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10350 E DAKOTA AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80247-1314
Practice Address - Country:US
Practice Address - Phone:303-338-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO36129207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO008667OtherKAISER-COMMERCIAL NUMBER
CO01361294Medicaid
CO01361294Medicaid
CO008667OtherKAISER-COMMERCIAL NUMBER
COCK10559Medicare PIN