Provider Demographics
NPI:1316978984
Name:MOHMAND, BEHRAM K (MD)
Entity type:Individual
Prefix:
First Name:BEHRAM
Middle Name:K
Last Name:MOHMAND
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 1:9397 CROWN CREST BLVD STE 401
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-8789
Mailing Address - Country:US
Mailing Address - Phone:303-697-1636
Mailing Address - Fax:303-805-9948
Practice Address - Street 1:9397 CROWN CREST BLVD STE 401
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-8789
Practice Address - Country:US
Practice Address - Phone:303-697-1636
Practice Address - Fax:303-805-9948
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO49554207RN0300X
KY39204207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01609530Medicaid
KY64104904Medicaid
KY64104904Medicaid
KY0656609Medicare ID - Type Unspecified
KY0656508Medicare ID - Type Unspecified
COCOA103693Medicare Oscar/Certification
I31096Medicare UPIN
KY0685907Medicare ID - Type Unspecified