Provider Demographics
NPI:1902940711
Name:RICHARD E ALBIM MD PH DDC
Entity type:Organization
Organization Name:RICHARD E ALBIM MD PH DDC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ELLIS
Authorized Official - Last Name:ALBIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD PHD
Authorized Official - Phone:303-839-9000
Mailing Address - Street 1:1601 E 19TH AVENUE
Mailing Address - Street 2:SUITE 4350
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1253
Mailing Address - Country:US
Mailing Address - Phone:303-839-9000
Mailing Address - Fax:303-832-3748
Practice Address - Street 1:1601 E 19TH AVENUE
Practice Address - Street 2:SUITE 4350
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1253
Practice Address - Country:US
Practice Address - Phone:303-839-9000
Practice Address - Fax:303-832-3748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO21643208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01216431Medicaid
2251Medicare ID - Type Unspecified
CO01216431Medicaid