Provider Demographics
NPI:1336184886
Name:COVILLE, FREDERICK V (MD)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:V
Last Name:COVILLE
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 1:4900 S MONACO ST
Mailing Address - Street 2:#210
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3486
Mailing Address - Country:US
Mailing Address - Phone:303-789-2663
Mailing Address - Fax:303-788-4871
Practice Address - Street 1:799 E HAMPDEN AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2766
Practice Address - Country:US
Practice Address - Phone:303-789-2663
Practice Address - Fax:303-788-4871
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
CO22413207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01224138Medicaid
WY129802000Medicaid
NE1245556091Medicaid
KS100229640EMedicaid
KS100229640EMedicaid
COP01141075Medicare PIN
WY129802000Medicaid