Provider Demographics
NPI:1992720817
Name:GARLICK, IVOR (MD)
Entity type:Individual
Prefix:DR
First Name:IVOR
Middle Name:
Last Name:GARLICK
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 1:1211 S PARKER RD
Mailing Address - Street 2:#100
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-2155
Mailing Address - Country:US
Mailing Address - Phone:303-873-6990
Mailing Address - Fax:303-355-1737
Practice Address - Street 1:1211 S PARKER RD
Practice Address - Street 2:#100
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-2155
Practice Address - Country:US
Practice Address - Phone:303-873-6990
Practice Address - Fax:303-355-1737
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO22799207R00000X, 207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01227990Medicaid
D24159Medicare UPIN
CO01227990Medicaid