Provider Demographics
NPI:1992789051
Name:NORTHCOTE, KENT S (MD)
Entity type:Individual
Prefix:DR
First Name:KENT
Middle Name:S
Last Name:NORTHCOTE
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 1:135 IROQUOIS DR
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303
Mailing Address - Country:US
Mailing Address - Phone:303-709-4485
Mailing Address - Fax:303-306-7753
Practice Address - Street 1:2550 S PARKER RD
Practice Address - Street 2:STE 206
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1622
Practice Address - Country:US
Practice Address - Phone:303-306-7783
Practice Address - Fax:303-306-7753
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO40196207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COP00282077OtherRAILROAD MEDICARE
CO29175844Medicaid
COH31475Medicare UPIN
C803249Medicare PIN
COP00282077OtherRAILROAD MEDICARE