Basic Information
| Provider Information | |||||||||
| NPI: | 1245377522 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FENNIMORE | ||||||||
| FirstName: | ROBIN | ||||||||
| MiddleName: | MACCOLL | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MACCOLL | ||||||||
| OtherFirstName: | CYNTHIA | ||||||||
| OtherMiddleName: | ROBERTON | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4500 E 9TH AVE | ||||||||
| Address2: | STE 200 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802203911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033990055 | ||||||||
| FaxNumber: | 3033997764 | ||||||||
| Practice Location | |||||||||
| Address1: | 4500 E 9TH AVE | ||||||||
| Address2: | STE 200 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802203911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033990055 | ||||||||
| FaxNumber: | 3033997764 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2007 | ||||||||
| LastUpdateDate: | 12/09/2010 | ||||||||
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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 | 207VX0000X | 48850 | CO | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Obstetrics |
No ID Information.