Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | DR.0059068 | CO |
N | 111NI0900X | Internist | DR.0059068 | CO |
N | 207RC0000X | Internist - Cardiovascular Disease | DR.0059068 | CO |
Y | 207RI0011X | Interventional Cardiology | DR.0059068 | CO |
NPI | 1073737664 |
---|---|
Provider Name | Dr. Srinivas Iyengar |
First Address | Boulder, CO 80301-2709 |
Second Address | Boulder, CO 80303-1128 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2007 |
Last Update Date | 09/11/2017 |