Provider Demographics
NPI:1790759843
Name:GYSIN, OLIVER
Entity Type:Individual
Prefix:DR
First Name:OLIVER
Middle Name:
Last Name:GYSIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2185 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-2534
Mailing Address - Country:US
Mailing Address - Phone:303-296-2244
Mailing Address - Fax:303-296-2244
Practice Address - Street 1:1440 VINE ST
Practice Address - Street 2:BRIARWOOD
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-2016
Practice Address - Country:US
Practice Address - Phone:303-399-0350
Practice Address - Fax:303-333-4841
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1500103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07009848Medicaid
COC99586Medicare ID - Type Unspecified