Provider Demographics
NPI:1558389221
Name:LINK, DAVID WAYNE (MD MPH)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:WAYNE
Last Name:LINK
Suffix:
Gender:M
Credentials:MD MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-3586
Mailing Address - Country:US
Mailing Address - Phone:303-440-3200
Mailing Address - Fax:303-440-3232
Practice Address - Street 1:2750 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3573
Practice Address - Country:US
Practice Address - Phone:303-440-3200
Practice Address - Fax:303-440-3232
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO30981207P00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01309814Medicaid
NE1558389221Medicaid
CO930005409OtherRAILROAD MEDICARE
NE1558389221Medicaid
CO930005409OtherRAILROAD MEDICARE
CO01309814Medicaid