Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 155137 | MA |
N | 111NI0900X | Internist | 155137 | MA |
N | 207R00000X | Internist | 38341 | WI |
N | 111NI0900X | Internist | 38341 | WI |
N | 207R00000X | Internist | 8789 | MT |
N | 111NI0900X | Internist | 8789 | MT |
N | 207RN0300X | Nephrologist | 155137 | MA |
Y | 207RN0300X | Nephrologist | 51352 | CO |
N | 207RN0300X | Nephrologist | 8789 | MT |
NPI | 1043280407 |
---|---|
Provider Name | Bijan Roshan |
First Address | Denver, CO 80210-5073 |
Second Address | Denver, CO 80210-5073 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2006 |
Last Update Date | 26/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
20028270 | (05) | CO |
3205398 | (05) | MA |
9988792 | (05) | MT |
COA108620 | INDIVIDUAL PTAN (01) | CO |
H08439 | (02) | MA |
HZA430 | (02) | MT |