Basic Information
| Provider Information | |||||||||
| NPI: | 1477575686 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOHLMAN | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5200 DTC PKWY | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | GREENWOOD VILLAGE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801112719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037450000 | ||||||||
| FaxNumber: | 3037733101 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 S BURMA AVE | ||||||||
| Address2: | |||||||||
| City: | GILLETTE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 827163426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3076881000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2006 | ||||||||
| LastUpdateDate: | 10/14/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 51632 | CO | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 5101012372 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 51632 | CO | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | 12468A | WY | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 85006246 | 05 | CO | MEDICAID |