Provider Demographics
NPI:1982633442
Name:SIROOSPOUR, DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:SIROOSPOUR
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 1:8120 S HOLLY ST
Mailing Address - Street 2:SUITE 111
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122-4005
Mailing Address - Country:US
Mailing Address - Phone:303-741-4060
Mailing Address - Fax:720-200-9444
Practice Address - Street 1:8120 S HOLLY ST
Practice Address - Street 2:SUITE 111
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80122-4005
Practice Address - Country:US
Practice Address - Phone:303-741-4060
Practice Address - Fax:720-200-9444
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO374162086S0129X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC804391Medicare PIN
COA54844Medicare UPIN
COC804390Medicare PIN
CO804391Medicare ID - Type Unspecified