Provider Demographics
NPI:1447302468
Name:NEUBAUM, NICHOLAS E (MD)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:E
Last Name:NEUBAUM
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:1800 E PAVILION PL
Mailing Address - Street 2:SUITE B
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-5337
Mailing Address - Country:US
Mailing Address - Phone:970-249-1210
Mailing Address - Fax:970-249-3057
Practice Address - Street 1:1800 E PAVILION PL
Practice Address - Street 2:SUITE B
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-5337
Practice Address - Country:US
Practice Address - Phone:970-249-1210
Practice Address - Fax:970-249-3057
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-10-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO40320207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO10286357Medicaid
659917OtherBLUE CROSS BLUESHIELD
P00151891OtherRAILROAD MEDICARE
840851676007OtherROCKY MOUNTAIN HEALTH PLA
H57921Medicare UPIN
C548538Medicare PIN