Individual
EDWIN F. DEZOETEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
13123 EAST 16TH AVENUE, THE CHILDREN'S HOSPITAL, AURORA, CO 80045-7106
(720) 777-1234
Mailing address
PO BOX 110429, AURORA, CO 80042-0429
(303) 493-7000
Taxonomy
Speciality
Code
Description
License number
State
2080P0206X
Pediatric Gastroenterology Physician
Primary
49029
CO
2080P0206X
Pediatric Gastroenterology Physician
MD424151
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30484235
—
CO
Enumeration date
05/18/2007
Last updated
08/12/2013
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