Basic Information
| Provider Information | |||||||||
| NPI: | 1780648378 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CONYERS | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8550 W 38TH AVE | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | WHEAT RIDGE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800334300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034211440 | ||||||||
| FaxNumber: | 3034212524 | ||||||||
| Practice Location | |||||||||
| Address1: | 4740 PEARL PKWY STE 200 | ||||||||
| Address2: | |||||||||
| City: | BOULDER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 803013080 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034492730 | ||||||||
| FaxNumber: | 3034495821 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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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 | 174400000X | 26818 | CO | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 1268184 | 05 | CO | MEDICAID | 400000514 | 01 | CO | RAIL ROAD MEDICARE | OTHER |