Provider Demographics
NPI:1558370379
Name:DOBROW, MALCOLM S (MD)
Entity Type:Individual
Prefix:
First Name:MALCOLM
Middle Name:S
Last Name:DOBROW
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 1:10700 E GEDDES AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3861
Mailing Address - Country:US
Mailing Address - Phone:303-761-9190
Mailing Address - Fax:720-874-4462
Practice Address - Street 1:1501 S POTOMAC ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-5411
Practice Address - Country:US
Practice Address - Phone:303-761-9190
Practice Address - Fax:720-874-4462
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO201462085R0202X
NE251572085R0202X
KS04-362962085R0202X
HIMD175432085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1558370379Medicaid
CO01201466Medicaid
KS200424880AMedicaid
OK200425120AMedicaid
TX205735801Medicaid
MO209903806Medicaid
MI104686070Medicaid
IA1558370379Medicaid
UT1679513196Medicaid
AZ179544Medicaid
NE84-059792913Medicaid
WI99112263Medicaid
CA1558370379Medicaid
IL1558370379Medicaid
OH2736490Medicaid
CA1558370379Medicaid
COCW5368Medicare PIN
COCO305628Medicare PIN
OK200425120AMedicaid
KS200424880AMedicaid
UT1679513196Medicaid
WY1558370379Medicaid
COCW4368Medicare PIN
CO30089955Medicare PIN
COC22434Medicare PIN
D23720Medicare UPIN
WI99112263Medicaid
NENA2517046Medicare PIN