Provider Demographics
NPI:1730126202
Name:AMBLER, ANDREW WAYNE (DO)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:WAYNE
Last Name:AMBLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 E HARVARD AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-7007
Mailing Address - Country:US
Mailing Address - Phone:303-777-0781
Mailing Address - Fax:303-777-0786
Practice Address - Street 1:950 E HARVARD AVE STE 140
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-7007
Practice Address - Country:US
Practice Address - Phone:303-777-0781
Practice Address - Fax:303-777-0786
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0051957207RI0200X
MI5101015497207RI0200X
LA000250207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1022017260001Medicaid
I56454Medicare UPIN
PA1022017260001Medicaid