Provider Demographics
NPI:1336202712
Name:ARCHULETA, MAURICE A (MD)
Entity Type:Individual
Prefix:DR
First Name:MAURICE
Middle Name:A
Last Name:ARCHULETA
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 1:6301 W 38TH AVE
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-5057
Mailing Address - Country:US
Mailing Address - Phone:303-940-9118
Mailing Address - Fax:303-940-5943
Practice Address - Street 1:6301 W 38TH AVE
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-5057
Practice Address - Country:US
Practice Address - Phone:303-940-9118
Practice Address - Fax:303-940-5943
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO27027207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01270271Medicaid
CO01270271Medicaid
COD24888Medicare UPIN