Provider Demographics
NPI:1689616831
Name:DAEHN, MARY J (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:J
Last Name:DAEHN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:566 AZTEC DRIVE
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303
Mailing Address - Country:US
Mailing Address - Phone:303-430-0240
Mailing Address - Fax:303-430-5883
Practice Address - Street 1:11166 HURON ST STE 27
Practice Address - Street 2:
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80234-3339
Practice Address - Country:US
Practice Address - Phone:303-430-0240
Practice Address - Fax:303-430-5883
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO28506207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC498808Medicare PIN
COE40482Medicare UPIN