Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 26796 | CO |
NPI | 1730214487 |
---|---|
Provider Name | Dr. James Boland |
First Address | Englewood, CO 80112-7056 |
Second Address | Englewood, CO 80112-7056 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2007 |
Last Update Date | 08/07/2007 |