Provider Demographics
NPI:1952537557
Name:BOEDECKER, ANDREA ELAINE (DO)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:ELAINE
Last Name:BOEDECKER
Suffix:
Gender:F
Credentials:DO
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Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2030 MOUNTAIN VIEW AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-3178
Mailing Address - Country:US
Mailing Address - Phone:720-652-8444
Mailing Address - Fax:
Practice Address - Street 1:11230 BENTON ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80020-3275
Practice Address - Country:US
Practice Address - Phone:720-282-8010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-09
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0055767208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery