Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 28684 | CO |
NPI | 1326069998 |
---|---|
Provider Name | Dr. Nathan Michael Josephs |
First Address | Boulder, CO 80301 |
Second Address | Boulder, CO 80301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 03/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01286848 | (05) | CO |
E46945 | (02) | CO |