Provider Demographics
NPI:1295732022
Name:ROSENBLUM, PHILIP J (MD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:J
Last Name:ROSENBLUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3655 E 104TH AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80233-4469
Mailing Address - Country:US
Mailing Address - Phone:303-254-8500
Mailing Address - Fax:303-453-1819
Practice Address - Street 1:3655 E 104TH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80233-4469
Practice Address - Country:US
Practice Address - Phone:303-254-8500
Practice Address - Fax:303-453-1819
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO36004207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO69954313Medicaid
CO69954313Medicaid
CB1989Medicare PIN
COB1989Medicare ID - Type Unspecified