Provider Demographics
NPI:1457797599
Name:BERUBE, COLETTE THERESE (MD)
Entity Type:Individual
Prefix:DR
First Name:COLETTE
Middle Name:THERESE
Last Name:BERUBE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:COLETTE
Other - Middle Name:THERESE
Other - Last Name:HARRINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10350 E DAKOTA AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-1314
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1375 E 19TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1114
Practice Address - Country:US
Practice Address - Phone:303-338-4545
Practice Address - Fax:303-344-7715
Is Sole Proprietor?:No
Enumeration Date:2013-05-16
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125-063034207P00000X
CODR.0059169207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO028947OtherKAISER COMMERCIAL NUMBER
CO9000153214Medicaid