Provider Demographics
NPI:1497908362
Name:ALL SPORTS MEDICINE OF BOULDER
Entity Type:Organization
Organization Name:ALL SPORTS MEDICINE OF BOULDER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:720-563-9469
Mailing Address - Street 1:3825 IRIS AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2003
Mailing Address - Country:US
Mailing Address - Phone:720-563-9469
Mailing Address - Fax:
Practice Address - Street 1:3825 IRIS AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-2003
Practice Address - Country:US
Practice Address - Phone:720-563-9469
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-23
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCF88260Medicare UPIN