Provider Demographics
NPI:1265427462
Name:LUBOW, ALAN T (DO)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:T
Last Name:LUBOW
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 S PEARL ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-4221
Mailing Address - Country:US
Mailing Address - Phone:303-744-9120
Mailing Address - Fax:303-744-3234
Practice Address - Street 1:811 S PEARL ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-4221
Practice Address - Country:US
Practice Address - Phone:303-744-9120
Practice Address - Fax:303-744-3234
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-13
Last Update Date:2007-07-08
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
CO25458207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO25458OtherMEDICAL LICENSE