Provider Demographics
NPI:1336172774
Name:MAURICIO WAINTRUB, M.D., P.C
Entity Type:Organization
Organization Name:MAURICIO WAINTRUB, M.D., P.C
Other - Org Name:ROCKY MOUNTAIN INTERNAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAURICIO
Authorized Official - Middle Name:
Authorized Official - Last Name:WAINTRUB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-337-5575
Mailing Address - Street 1:1360 S POTOMAC ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-4505
Mailing Address - Country:US
Mailing Address - Phone:303-337-5575
Mailing Address - Fax:303-745-6264
Practice Address - Street 1:1360 S POTOMAC ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-4505
Practice Address - Country:US
Practice Address - Phone:303-337-5575
Practice Address - Fax:303-745-6264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO34568207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO13037366Medicaid
CO13037366Medicaid