Provider Demographics
NPI:1780104778
Name:ROZEBOOM, PAUL DEAN (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:DEAN
Last Name:ROZEBOOM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9399 CROWN CREST BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-8508
Mailing Address - Country:US
Mailing Address - Phone:303-805-1855
Mailing Address - Fax:
Practice Address - Street 1:9399 CROWN CREST BLVD STE 325
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-8572
Practice Address - Country:US
Practice Address - Phone:303-805-1855
Practice Address - Fax:303-805-4421
Is Sole Proprietor?:No
Enumeration Date:2017-06-21
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU0840208600000X
NDRL14687208600000X
CODR.0073993208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000183827Medicaid