Provider Demographics
NPI:1598886483
Name:ROESNER, NATHAN (DO)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:
Last Name:ROESNER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11700 W 2ND PL
Mailing Address - Street 2:MEDICAL PLAZA 2 STE 210
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-1704
Mailing Address - Country:US
Mailing Address - Phone:303-909-6977
Mailing Address - Fax:303-954-4779
Practice Address - Street 1:2595 CANYON BLVD STE 360
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-6745
Practice Address - Country:US
Practice Address - Phone:303-440-7546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101017089208600000X
CO50492208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO75531267Medicaid