Provider Demographics
NPI:1770648719
Name:ZUBLIN, GUY M (MD)
Entity type:Individual
Prefix:
First Name:GUY
Middle Name:M
Last Name:ZUBLIN
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 1:4295 REDWOOD PL
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1638
Mailing Address - Country:US
Mailing Address - Phone:303-579-2190
Mailing Address - Fax:
Practice Address - Street 1:7695 CHURCH RANCH BLVD UNIT 100
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80021-5545
Practice Address - Country:US
Practice Address - Phone:303-635-2273
Practice Address - Fax:303-635-1225
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO36858208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO74228765Medicaid
CO74228765Medicaid
CO20-2706509OtherTIN
CO74228765Medicaid