Basic Information
| Provider Information | |||||||||
| NPI: | 1033481056 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DOFEK | ||||||||
| FirstName: | BRETISLAV | ||||||||
| MiddleName: | JOSEF | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1661 S PARFET CT | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802326130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3035258990 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4500 CHERRY CREEK DR. SOUTH | ||||||||
| Address2: | SUITE 940 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033227108 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2012 | ||||||||
| LastUpdateDate: | 02/07/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 296 | 01 | CO | MAXIM | OTHER |