Provider Demographics
NPI:1023052891
Name:DAHL, CARL ROBERT (MD)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:ROBERT
Last Name:DAHL
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 1:10403 W COLFAX AVE STE 630
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80215-3812
Mailing Address - Country:US
Mailing Address - Phone:303-205-1090
Mailing Address - Fax:303-205-1120
Practice Address - Street 1:8550 W 38TH AVE STE 300
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-4355
Practice Address - Country:US
Practice Address - Phone:303-463-3900
Practice Address - Fax:303-463-3999
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO17461207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01174614Medicaid
CO100010928OtherRAILROAD MEDICARE
CO01174614Medicaid
CO100010928OtherRAILROAD MEDICARE