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General NPI Number Information
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NPI Number | 1194071605
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Entity Type | Organization
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Legal Business Name | BOULDER GYNECOLOGY & MINIMALLY INVASIVE SURGERY
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Dates
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Enumeration Date | 08/02/2012
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Last Update Date | 08/02/2012
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Provider Practice Location Address
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Address Line | 4800 RIVERBEND RD SUITE 200
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City | BOULDER
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State | CO
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Zip | 80301-2636
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Country | US
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Telephone | 720-382-2621
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Fax | 720-382-2625
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Provider Business Mailing Address
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Address Line | 4800 RIVERBEND RD SUITE 200
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City | BOULDER
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State | CO
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Zip | 80301-2636
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Country | US
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Telephone | 720-382-2621
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Fax | 720-382-2625
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | LISA LEPINE
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Credential | M.D.
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Telephone | 720-382-2621
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 43874
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License Number State | CO
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