Healthcare Provider Details

I. General information

NPI: 1346537370
Provider Name (Legal Business Name): ANEESH GARG D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2011
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1790 30TH ST STE 270
BOULDER CO
80301-1085
US

IV. Provider business mailing address

1790 30TH ST STE 270
BOULDER CO
80301-1085
US

V. Phone/Fax

Practice location:
  • Phone: 303-997-1733
  • Fax:
Mailing address:
  • Phone: 303-997-1733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number036.139147
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number4058
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License NumberDR.0069417
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: