Healthcare Provider Details

I. General information

NPI: 1497908362
Provider Name (Legal Business Name): ALL SPORTS MEDICINE OF BOULDER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2008
Last Update Date: 10/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3825 IRIS AVE SUITE 300
BOULDER CO
80301-2003
US

IV. Provider business mailing address

3825 IRIS AVE SUITE 300
BOULDER CO
80301-2003
US

V. Phone/Fax

Practice location:
  • Phone: 720-563-9469
  • Fax:
Mailing address:
  • Phone: 720-563-9469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LISA BRONE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 720-563-9469