Provider Demographics
NPI:1750437315
Name:PANE, ROBERT D (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:D
Last Name:PANE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5450 WESTERN AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2709
Mailing Address - Country:US
Mailing Address - Phone:303-415-4325
Mailing Address - Fax:303-661-9496
Practice Address - Street 1:1000 W SOUTH BOULDER RD
Practice Address - Street 2:SUITE 214
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-2752
Practice Address - Country:US
Practice Address - Phone:303-604-6669
Practice Address - Fax:303-661-9496
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2017-11-09
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Provider Licenses
StateLicense IDTaxonomies
CODR.0021046207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01210467Medicaid
CO01210467Medicaid
COCK10310Medicare PIN
COF15028Medicare UPIN
COCO306863Medicare PIN