Provider Demographics
NPI:1457612848
Name:BABCOCK, AMANDA O'STEEN (MD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:O'STEEN
Last Name:BABCOCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:O'STEEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 9049
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-9049
Mailing Address - Country:US
Mailing Address - Phone:303-415-8940
Mailing Address - Fax:303-425-9259
Practice Address - Street 1:3 SUPERIOR DR STE 100B
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:CO
Practice Address - Zip Code:80027-8653
Practice Address - Country:US
Practice Address - Phone:303-415-8940
Practice Address - Fax:303-425-9259
Is Sole Proprietor?:No
Enumeration Date:2012-06-02
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA127022207Q00000X
CODR.0061542207QS0010X, 207Q00000X
MO2023000976207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000170691Medicaid
MO200118993Medicaid