Provider Demographics
NPI:1548317894
Name:WAKEFIELD, HAROLD1 R (MD)
Entity type:Individual
Prefix:DR
First Name:HAROLD1
Middle Name:R
Last Name:WAKEFIELD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1686 S FAIRFAX ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-3830
Mailing Address - Country:US
Mailing Address - Phone:303-756-3495
Mailing Address - Fax:
Practice Address - Street 1:4900 CHERRY CREEK SOUTH DR
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-2283
Practice Address - Country:US
Practice Address - Phone:303-316-4190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO169572084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
COD49932Medicare UPIN