Provider Demographics
NPI:1326069998
Name:JOSEPHS, NATHAN MICHAEL (DO)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:MICHAEL
Last Name:JOSEPHS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3055 47TH STREET
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301
Mailing Address - Country:US
Mailing Address - Phone:303-447-0550
Mailing Address - Fax:303-447-9570
Practice Address - Street 1:3055 47TH STREET
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301
Practice Address - Country:US
Practice Address - Phone:303-447-0550
Practice Address - Fax:303-447-9570
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO28684207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01286848Medicaid
COCJ4818Medicare PIN
COE46945Medicare UPIN