Provider Demographics
NPI:1245282862
Name:MOGHIM, ROBERT Z (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:Z
Last Name:MOGHIM
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 1:755 HERITAGE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-3600
Mailing Address - Country:US
Mailing Address - Phone:303-277-0700
Mailing Address - Fax:303-277-0714
Practice Address - Street 1:755 HERITAGE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-3600
Practice Address - Country:US
Practice Address - Phone:303-277-0700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR0039871207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI15559Medicare UPIN