Provider Demographics
NPI:1922142629
Name:MCDUFFIE, ROBERT S JR (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
Last Name:MCDUFFIE
Suffix:JR
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 1:1960 N OGDEN ST
Mailing Address - Street 2:SUITE 330
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-3666
Mailing Address - Country:US
Mailing Address - Phone:303-318-2610
Mailing Address - Fax:303-318-2619
Practice Address - Street 1:1960 N OGDEN ST
Practice Address - Street 2:SUITE 330
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-3666
Practice Address - Country:US
Practice Address - Phone:303-318-2610
Practice Address - Fax:303-318-2619
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO24966207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
004192OtherKAISER-COMMERCIAL NUMBER
CO01249663Medicaid
COCOA100793Medicare PIN
COF15648Medicare UPIN
004192OtherKAISER-COMMERCIAL NUMBER