Active NPI
Frederick S Wamboldt, MD
- Neurology Physician
- Denver, CO
National Provider Identifier
1740350438
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- 29680
- Practice address
- 1400 Jackson St
Denver, CO 80206-2761 - Phone
- (303) 388-4461
- Fax
- (303) 270-2174
- NPI assigned
- Nov 9, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | 29680 | CO | Primary |
Addresses
Primary practice location
1400 Jackson St
Denver, CO 80206-2761
Mailing address
1400 Jackson St
Denver, CO 80206-2761
Phone (303) 388-4461
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01296805 | Medicaid | CO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 29680 | CO | MD | Neurology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163030400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1581897600000",
"number": "1740350438",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1400 JACKSON ST",
"city": "DENVER",
"state": "CO",
"postal_code": "802062761",
"telephone_number": "303-388-4461",
"fax_number": "303-270-2174"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1400 JACKSON ST",
"city": "DENVER",
"state": "CO",
"postal_code": "802062761",
"telephone_number": "303-388-4461",
"fax_number": "303-270-2174"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAMBOLDT",
"first_name": "FREDERICK",
"middle_name": "S",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-09",
"last_updated": "2020-02-17",
"certification_date": "2020-02-17",
"status": "A"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "CO",
"license": "29680",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01296805",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Denver, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.