Healthcare Provider Details

I. General information

NPI: 1780818286
Provider Name (Legal Business Name): CHRISTIE BEAN BLANTON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHRISTIE J BEAN MD

II. Dates (important events)

Enumeration Date: 05/12/2009
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 BROADWAY ST
BOULDER CO
80304-3586
US

IV. Provider business mailing address

2750 BROADWAY ST
BOULDER CO
80304-3586
US

V. Phone/Fax

Practice location:
  • Phone: 303-440-3216
  • Fax: 303-440-3209
Mailing address:
  • Phone: 303-440-3216
  • Fax: 303-440-3209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD.204373
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberCDRH.0065507
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number76444
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number72305
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: