Provider Demographics
NPI:1184708497
Name:ROSSIE, GEORGE V (PHD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:V
Last Name:ROSSIE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 W CONEJOS PL
Mailing Address - Street 2:#111
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-1333
Mailing Address - Country:US
Mailing Address - Phone:303-893-9300
Mailing Address - Fax:303-893-4384
Practice Address - Street 1:4200 W CONEJOS PL
Practice Address - Street 2:#111
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-1333
Practice Address - Country:US
Practice Address - Phone:303-893-9300
Practice Address - Fax:303-893-4384
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO799174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COM19989OtherSTATE WORK COMP
CO186491300OtherOWCP
CO92675701Medicaid
CO92675701Medicaid
COM19989OtherSTATE WORK COMP