Basic Information
| Provider Information | |||||||||
| NPI: | 1720067671 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WAY | ||||||||
| FirstName: | DEBORAH | ||||||||
| MiddleName: | ELIZABETH | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 5730 WARD RD | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | ARVADA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800021300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034226331 | ||||||||
| FaxNumber: | 3034886379 | ||||||||
| Practice Location | |||||||||
| Address1: | 5730 WARD RD | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | ARVADA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800021300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034226331 | ||||||||
| FaxNumber: | 3034886379 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2006 | ||||||||
| LastUpdateDate: | 08/24/2016 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 28280 | CO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1720067671 | 01 | NPI # | OTHER | 5471507 | 01 | CO | AETNA | OTHER | WA103078 | 01 | CO | ANTHEM BCBS | OTHER | 513142 | 01 | CO | MEDICARE GROUP NUMBER | OTHER | RO103008 | 01 | CT | GROUP NTHEM BCBS | OTHER | 1215981634 | 01 | GROUP NPI # | OTHER | 841365302019 | 01 | CO | RKY MTN HMO | OTHER | 01282805 | 05 | CO | MEDICAID | 04020541 | 05 | CO | MEDICAID | 276004 | 01 | CO | CIGNA | OTHER | 84136530204 | 01 | CO | PACIFICARE | OTHER | 84136530207 | 01 | CO | PACIFICARE PPO | OTHER |