Healthcare Provider Details

I. General information

NPI: 1720138639
Provider Name (Legal Business Name): JUSTIN BRIAN MAXHIMER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 SPRUCE ST STE 201
BOULDER CO
80302-4839
US

IV. Provider business mailing address

1215 SPRUCE ST STE 201
BOULDER CO
80302-4839
US

V. Phone/Fax

Practice location:
  • Phone: 303-443-2277
  • Fax: 303-443-7124
Mailing address:
  • Phone: 303-443-2277
  • Fax: 303-443-7124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberDR54921
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: