Provider Demographics
NPI:1760861256
Name:MODY, ROXANNE R (MD)
Entity Type:Individual
Prefix:DR
First Name:ROXANNE
Middle Name:R
Last Name:MODY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 E 19TH AVE STE 4200
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1286
Mailing Address - Country:US
Mailing Address - Phone:303-861-4914
Mailing Address - Fax:303-861-8615
Practice Address - Street 1:1601 E 19TH AVE STE 4200
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1286
Practice Address - Country:US
Practice Address - Phone:303-861-4914
Practice Address - Fax:303-861-8615
Is Sole Proprietor?:No
Enumeration Date:2015-05-29
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COTL0005513390200000X
CO0059821207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program