Provider Demographics
NPI:1639151459
Name:DOBIJA, CEZARY ANTONI (MD)
Entity Type:Individual
Prefix:
First Name:CEZARY
Middle Name:ANTONI
Last Name:DOBIJA
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 1:5450 WESTERN AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2709
Mailing Address - Country:US
Mailing Address - Phone:303-415-4325
Mailing Address - Fax:303-661-9496
Practice Address - Street 1:1000 W SOUTH BOULDER RD
Practice Address - Street 2:STE. 214
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-2752
Practice Address - Country:US
Practice Address - Phone:303-604-6669
Practice Address - Fax:303-661-9496
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO37214207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01372143Medicaid
CO01372143Medicaid
CO110225586Medicare PIN
COC507758Medicare PIN