Basic Information
| Provider Information | |||||||||
| NPI: | 1487640462 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WOLVERTON | ||||||||
| FirstName: | DULCY | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10700 E. GEDDES AVE | ||||||||
| Address2: | ATTN: CREDENTIALING | ||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801123681 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037619190 | ||||||||
| FaxNumber: | 3037616278 | ||||||||
| Practice Location | |||||||||
| Address1: | 10700 E. GEDDES AVE | ||||||||
| Address2: | ATTN: CREDENTIALING | ||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801123681 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037619190 | ||||||||
| FaxNumber: | 3037616278 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2005 | ||||||||
| LastUpdateDate: | 07/31/2012 | ||||||||
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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 | 2085R0202X | G73834 | CA | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 46302 | CO | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 1487640462 | 05 | WY | MEDICAID | 1487640462 | 05 | CA | MEDICAID | 55580033 | 05 | CO | MEDICAID | 200875450A | 05 | KS | MEDICAID | 73428752 | 05 | NM | MEDICAID | 1487640462 | 05 | MT | MEDICAID | 84059792913 | 05 | NE | MEDICAID |