Provider Demographics
NPI:1811043409
Name:BOSWORTH, CORTNEY RAY (MD)
Entity Type:Individual
Prefix:DR
First Name:CORTNEY
Middle Name:RAY
Last Name:BOSWORTH
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 1:130 RAMPART WAY, STE 300B
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-6451
Mailing Address - Country:US
Mailing Address - Phone:303-327-4700
Mailing Address - Fax:303-327-4711
Practice Address - Street 1:3550 LUTHERAN PKWY
Practice Address - Street 2:BLDG 10 SUITE 200
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-6017
Practice Address - Country:US
Practice Address - Phone:720-536-2100
Practice Address - Fax:720-536-2090
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO46927207RN0300X, 207R00000X, 207RN0300X
CO1928207R00000X
COTL-1928390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1811043409OtherNPI
CO84485779Medicaid
CO1811043409OtherNPI