Individual
KEVIN SCOTT QUACKENBUSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4747 ARAPAHOE AVE, BOULDER, CO 80303-1131
(303) 415-7000
Mailing address
PO BOX 17389, DENVER, CO 80217-0389
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
DR.0068125
CO
390200000X
Student in an Organized Health Care Education/Training Program
TL.0007177
CO
Other
Enumeration date
03/30/2018
Last updated
01/18/2023
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