Healthcare Provider Details

I. General information

NPI: 1538128434
Provider Name (Legal Business Name): CARL ALBERT MORITZ JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 08/18/2023
Certification Date: 08/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2760 29TH ST SUITE 2B
BOULDER CO
80301
US

IV. Provider business mailing address

2760 29TH ST SUITE 2B
BOULDER CO
80301
US

V. Phone/Fax

Practice location:
  • Phone: 303-444-6400
  • Fax: 303-444-6465
Mailing address:
  • Phone: 303-444-6400
  • Fax: 303-444-6465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number26399
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: