MEDICARE: MARSDEN SCOTT BLOIS IV MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	J7308	TX
2	207RA0001X	Advanced Heart Failure and Transplant Cardiology Physician	DR.0034464	CO
3	207RC0000X	Cardiovascular Disease Physician	DR.0034464	CO

General Provider Information

NPI Number	:	1215938683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARSDEN SCOTT BLOIS IV MD

Provider Business Mailing Address
First Line	:	5450 WESTERN AVE
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80301-2709
Country	:	US
Telephone Number	:	303-442-2395
Fax Number	:	303-442-1073

Provider Business Practice Location Address
First Line	:	4743 ARAPAHOE AVE
Second Line	:	STE 201
City	:	BOULDER
State	:	CO
Zip	:	80303-1113
Country	:	US
Telephone Number	:	303-442-2395
Fax Number	:	303-442-1073

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	11/09/2017

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