Individual
DR. CARL W DEMIDOVICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
950 E HARVARD AVE, STE 440, DENVER, CO 80210-7009
(303) 744-2704
(303) 744-3244
Mailing address
950 E HARVARD AVE, STE 440, DENVER, CO 80210-7009
(303) 744-2704
(303) 744-3244
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
33910
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01339100
—
CO
01
—
070015071
RR MEDICARE
CO
01
—
19292
BCBS
CO
01
—
84-1511239
FEDERAL TAX ID
CO
Enumeration date
09/02/2006
Last updated
05/17/2013
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