1063549749 NPI number — GLORIA PATRICIA OBERBECK MD

Table of content: GLORIA PATRICIA OBERBECK MD (NPI 1063549749)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063549749 NPI number — GLORIA PATRICIA OBERBECK MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OBERBECK
Provider First Name:
GLORIA
Provider Middle Name:
PATRICIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BACHELDER
Provider Other First Name:
GLORIA
Provider Other Middle Name:
PATRICIA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1063549749
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/03/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 445
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ERIE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80516-0445
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-828-9200
Provider Business Mailing Address Fax Number:
303-828-9204

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
636 KATTELL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ERIE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80516-0445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-828-9200
Provider Business Practice Location Address Fax Number:
303-828-9204
Provider Enumeration Date:
02/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  32141 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: C803326 . This is a "MEDICARE GROUP PIN" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com