Healthcare Provider Details

I. General information

NPI: 1639312192
Provider Name (Legal Business Name): SETH TEBOCKHORST M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2009
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 29TH ST. SUITE 1292 #1255
BOULDER CO
80301-1010
US

IV. Provider business mailing address

1601 29TH ST UNIT 1292
BOULDER CO
80301-1010
US

V. Phone/Fax

Practice location:
  • Phone: 303-900-8946
  • Fax:
Mailing address:
  • Phone: 303-900-8946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License NumberCDRH.0054213
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberCDRH.0054213
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number21498
License Number StateND
# 4
Primary TaxonomyY
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License NumberCDRH.0054213
License Number StateCO
# 5
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberCDRH.0054213
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: