Provider Demographics
NPI:1770648719
Name:ZUBLIN, GUY M (MD)
Entity Type:Individual
Prefix:
First Name:GUY
Middle Name:M
Last Name:ZUBLIN
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 1:4237 REDWOOD CT
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1637
Mailing Address - Country:US
Mailing Address - Phone:303-440-2250
Mailing Address - Fax:
Practice Address - Street 1:1100 BALSAM AVE
Practice Address - Street 2:4TH FLOOR MAPLETON REHAB
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3404
Practice Address - Country:US
Practice Address - Phone:303-440-2250
Practice Address - Fax:303-440-2291
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO36858208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO74228765Medicaid
CO74228765Medicaid
CO20-2706509OtherTIN
CO74228765Medicaid