Basic Information
| Provider Information | |||||||||
| NPI: | 1235115254 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DREISBACH | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | N | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10700 E GEDDES AVE | ||||||||
| Address2: | NO 200 | ||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801123800 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 501 E HAMPDEN AVE | ||||||||
| Address2: | |||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801132702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037619190 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2005 | ||||||||
| LastUpdateDate: | 03/29/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 20148 | CO | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 02249241 | 01 | NY | NY MEDICAID | OTHER | 053213701 | 01 | TX | TX MEDICAID | OTHER | 64049026 | 01 | KY | KY MEDICAID | OTHER | 200364610 | 01 | IN | IN MEDICAID | OTHER | 104686089 | 01 | MI | MI MEDICAID | OTHER | 10025709000 | 05 | NE | MEDICAID | 117172100 | 01 | WY | WY MEDICAID | OTHER | 1235115254 | 05 | MT | MEDICAID | 424458 | 01 | AZ | AZ MEDICAID | OTHER | CO305739 | 01 | NE | MEDICARE TRAILBAZER RIN | OTHER | 200417090A | 01 | KS | KS MEDICAID | OTHER | 84-059792913 | 05 | NE | MEDICAID | 940000060 | 01 | CO | RR MCRE RIA | OTHER | 940000105 | 01 | CO | RR MCRE MIC | OTHER | XPY203373 | 01 | CA | CA MEDICAID | OTHER | 01201482 | 05 | CO | MEDICAID | 18155235 | 01 | NM | NM MEDICAID | OTHER |