Provider Demographics
NPI:1912942038
Name:ZUKOSKY, DEREK (DO)
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:
Last Name:ZUKOSKY
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 1:400 INDIANA ST STE 300
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-5027
Mailing Address - Country:US
Mailing Address - Phone:303-985-2550
Mailing Address - Fax:303-985-2586
Practice Address - Street 1:400 INDIANA ST STE 300
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-5027
Practice Address - Country:US
Practice Address - Phone:303-985-2550
Practice Address - Fax:303-985-2586
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO42927208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology