Provider Demographics
NPI:1922005610
Name:WILLIAM G SELF JR MD PC
Entity Type:Organization
Organization Name:WILLIAM G SELF JR MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-426-4810
Mailing Address - Street 1:8403 BRYANT ST
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80031-3809
Mailing Address - Country:US
Mailing Address - Phone:303-426-4810
Mailing Address - Fax:303-426-8708
Practice Address - Street 1:8403 BRYANT ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-3809
Practice Address - Country:US
Practice Address - Phone:303-426-4810
Practice Address - Fax:303-426-8708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
37801OtherBLUE CROSS/BLUE SHIELD
84078518A000OtherTRICARE
CO04510095Medicaid
490000213OtherRAILROAD MEDICARE
8163314OtherAETNA PPO
0971086OtherAETNA HMO
84078518A000OtherTRICARE
0971086OtherAETNA HMO