Basic Information
| Provider Information | |||||||||
| NPI: | 1427053974 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MACDONALD | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | MACLEAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4545 E 9TH AVE | ||||||||
| Address2: | STE 460 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802203904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033882922 | ||||||||
| FaxNumber: | 3033882962 | ||||||||
| Practice Location | |||||||||
| Address1: | 4545 E 9TH AVE STE 460 | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802203904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033882922 | ||||||||
| FaxNumber: | 3033882962 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2005 | ||||||||
| LastUpdateDate: | 08/12/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 35117 | CO | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1351170 | 05 | CO | MEDICAID |