Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 38620 | CO |
Y | 207Q00000X | Family Doctor | 38620 | CO |
N | 207Q00000X | Family Doctor | DOS-988 | HI |
NPI | 1114995024 |
---|---|
Provider Name | Dr. Eric Joseph Vanzura |
First Address | Boulder, CO 80305-5341 |
Second Address | Boulder, CO 80305-3304 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2006 |
Last Update Date | 09/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
27625737 | (05) | CO |
H43073 | (02) |