Healthcare Provider Details

I. General information

NPI: 1467552117
Provider Name (Legal Business Name): EMILY E. BUCY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2006
Last Update Date: 10/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 MAPLETON AVE
BOULDER CO
80304-3979
US

IV. Provider business mailing address

311 MAPLETON AVE
BOULDER CO
80304-3979
US

V. Phone/Fax

Practice location:
  • Phone: 303-441-0560
  • Fax: 303-441-2202
Mailing address:
  • Phone: 303-441-0560
  • Fax: 303-441-2202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number73729
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number45334
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: