Provider Demographics
NPI:1184695967
Name:TELLEZ, PATRICK ANTHONY (MD, MPH, MSHA)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:ANTHONY
Last Name:TELLEZ
Suffix:
Gender:M
Credentials:MD, MPH, MSHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-4541
Mailing Address - Country:US
Mailing Address - Phone:303-333-0248
Mailing Address - Fax:
Practice Address - Street 1:3701 S BROADWAY
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-3611
Practice Address - Country:US
Practice Address - Phone:303-761-1977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO24552207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1184695967Medicaid