Provider Demographics
NPI:1023303096
Name:MAYMANI, HOSSEIN (MD)
Entity type:Individual
Prefix:
First Name:HOSSEIN
Middle Name:
Last Name:MAYMANI
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 1:2030 MOUNTAIN VIEW AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-3180
Mailing Address - Country:US
Mailing Address - Phone:303-684-1900
Mailing Address - Fax:303-684-1925
Practice Address - Street 1:1760 E KEN PRATT BLVD STE 302
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80504-5311
Practice Address - Country:US
Practice Address - Phone:303-684-1900
Practice Address - Fax:303-684-1925
Is Sole Proprietor?:No
Enumeration Date:2011-06-17
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK28613207R00000X
CODR.0059632207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000158806Medicaid