Provider Demographics
NPI:1194782250
Name:WEISBROD, DENNIS MAURICE (MD)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:MAURICE
Last Name:WEISBROD
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 1:1601 E 19TH AVE
Mailing Address - Street 2:SUITE 4200
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1216
Mailing Address - Country:US
Mailing Address - Phone:303-831-8344
Mailing Address - Fax:303-861-8615
Practice Address - Street 1:1601 E 19TH AVE
Practice Address - Street 2:SUITE 4200
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1216
Practice Address - Country:US
Practice Address - Phone:303-831-8344
Practice Address - Fax:303-861-8615
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO17058207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01170588Medicaid
CO04760088Medicaid
COCOB4588Medicare PIN
COD23182Medicare UPIN
CO04760088Medicaid