Healthcare Provider Details

I. General information

NPI: 1093992224
Provider Name (Legal Business Name): RITTEL & JOSEPHSD.O. PROFESSIONAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2008
Last Update Date: 04/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3055 47TH STREET
BOULDER CO
80301-5469
US

IV. Provider business mailing address

3055 47TH STREET
BOULDER CO
80301-5469
US

V. Phone/Fax

Practice location:
  • Phone: 303-447-0550
  • Fax: 303-447-9570
Mailing address:
  • Phone: 303-447-0550
  • Fax: 303-447-9570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number28684
License Number StateCO

VIII. Authorized Official

Name: DR. NATHAN M. JOSEPHS
Title or Position: MEDICAL DIRECTOR
Credential: DO
Phone: 303-447-0550