Provider Demographics
NPI:1548370075
Name:LICHTENBERGER, GARY SCOTT (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:SCOTT
Last Name:LICHTENBERGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SCOTT
Other - Middle Name:
Other - Last Name:LICHTENBERGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:216 S ROSEMARY ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-6969
Mailing Address - Country:US
Mailing Address - Phone:303-363-8590
Mailing Address - Fax:
Practice Address - Street 1:4200 E 9TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80262-0001
Practice Address - Country:US
Practice Address - Phone:303-493-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO44252207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine