Provider Demographics
NPI:1659546265
Name:REECE, MIRIAM GRACE SPARKMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:GRACE SPARKMAN
Last Name:REECE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MIRIAM
Other - Middle Name:GRACE
Other - Last Name:SPARKMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4500 W 38TH AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80212-2001
Mailing Address - Country:US
Mailing Address - Phone:303-420-1297
Mailing Address - Fax:303-420-2953
Practice Address - Street 1:4500 W 38TH AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80212-2001
Practice Address - Country:US
Practice Address - Phone:303-420-1297
Practice Address - Fax:303-420-2953
Is Sole Proprietor?:No
Enumeration Date:2008-04-24
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA116454207Q00000X
CO49399207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO21037361Medicaid
CO21037361Medicaid