Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | DR.0056851 | CO |
NPI | 1093152985 |
---|---|
Provider Name | Dr. Amanda Regina Bogart |
First Address | Aurora, CO 80042-0429 |
Second Address | Aurora, CO 80045-2570 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2013 |
Last Update Date | 16/08/2019 |