Basic Information
| Provider Information | |||||||||
| NPI: | 1861440539 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ACHENBACH | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 777 S WADSWORTH BLVD | ||||||||
| Address2: | STE 220 | ||||||||
| City: | LAKEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802264300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3038139642 | ||||||||
| FaxNumber: | 3039879820 | ||||||||
| Practice Location | |||||||||
| Address1: | 10101 RIDGEGATE PKWY | ||||||||
| Address2: | |||||||||
| City: | LONE TREE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801245522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7202251267 | ||||||||
| FaxNumber: | 7202251269 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 207ZP0102X | 19563 | CO | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 01195635 | 05 | CO | MEDICAID |