NPI 1104987908 · Physician · Anthem
Moderate evidence supports active practice with 1 carrier network listing and verified licensure.
NPPES
CENTENNIAL, 80112
Freshness: Unknown
Network Status
Listed with 1 carrier
DORA License
Active
Medicare
Enrolled but no billing activity
Care Compare
No Care Compare data
PECOS Enrollment
Medicare enrolled
Order/Referring eligible: Yes
Active NPI with specialty classification
Active Colorado DORA license confirmed
No Medicare billing · No electronic endpoint
Single address source (NPPES)
Weak network corroboration
1 network across 1 carrier
Disclaimer: This analysis uses publicly available federal and state data sources. It does not constitute a determination of provider status or network participation. Contact the provider or health plan directly to verify current status.