Basic Information
| Provider Information | |||||||||
| NPI: | 1780617795 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FOOTHILLS UROLOGY, PC | ||||||||
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| OtherOrganizationName: | FOOTHILLS UROLOGY, PLLC | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25 CROSSROADS DR STE 306 | ||||||||
| Address2: | |||||||||
| City: | OWINGS MILLS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211175437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4437382872 | ||||||||
| FaxNumber: | 4437382872 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 INDIANA ST. | ||||||||
| Address2: | #300 | ||||||||
| City: | GOLDEN | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3039852550 | ||||||||
| FaxNumber: | 3039852586 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2006 | ||||||||
| LastUpdateDate: | 03/27/2019 | ||||||||
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| AuthorizedOfficialLastName: | CAHN | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3039852550 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 35416 | CO | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology | 208800000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |
No ID Information.