Provider Demographics
NPI:1427055409
Name:GOTTLIEB, THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:GOTTLIEB
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 1:1707 COLE BLVD
Mailing Address - Street 2:STE 250
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-3220
Mailing Address - Country:US
Mailing Address - Phone:303-763-4900
Mailing Address - Fax:303-763-5495
Practice Address - Street 1:9950 W 80TH AVE
Practice Address - Street 2:#23
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80005-3927
Practice Address - Country:US
Practice Address - Phone:303-425-1018
Practice Address - Fax:303-432-4770
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15276207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01152768Medicaid
CON1084Medicare ID - Type Unspecified
CO01152768Medicaid