Provider Demographics
NPI:1396373999
Name:BOOR, IAN C (MD)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:C
Last Name:BOOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1665 AURORA CT
Mailing Address - Street 2:SUITE 1032 MS F706
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045-2517
Mailing Address - Country:US
Mailing Address - Phone:720-848-0154
Mailing Address - Fax:720-848-0222
Practice Address - Street 1:1665 AURORA CT
Practice Address - Street 2:SUITE 1032 MS F706
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-2517
Practice Address - Country:US
Practice Address - Phone:720-848-0154
Practice Address - Fax:720-848-0222
Is Sole Proprietor?:No
Enumeration Date:2020-03-30
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN30766207R00000X
COTL0009483390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine