Healthcare Provider Details

I. General information

NPI: 1326069998
Provider Name (Legal Business Name): NATHAN MICHAEL JOSEPHS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 03/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3055 47TH STREET
BOULDER CO
80301
US

IV. Provider business mailing address

3055 47TH STREET
BOULDER CO
80301
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 TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number28684
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: