Basic Information
| Provider Information | |||||||||
| NPI: | 1003837709 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GILPIN | ||||||||
| FirstName: | MOLLY | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2650 18TH STREET SUITE 100 | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7205834470 | ||||||||
| FaxNumber: | 8884635887 | ||||||||
| Practice Location | |||||||||
| Address1: | 4500 E 9TH AVE | ||||||||
| Address2: | SUITE 740 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802203900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7209411778 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2006 | ||||||||
| LastUpdateDate: | 08/29/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 1714 | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 74874811 | 05 | CO | MEDICAID |