NPI 1104932888 · Family Medicine · Anthem
Strong multi-source corroboration of active practice across 3 carrier networks with confirmed Colorado DORA license.
NPPES
BOULDER, 80303
Freshness: Stale (last updated 2021-04-20)
1,782 days since update
Network Status
Listed with 4 carriers
DORA License
Active
Medicare
Enrolled but no billing activity
Care Compare
Address matches NPPES
PECOS Enrollment
Medicare enrolled
Order/Referring eligible: Yes
Active NPI with specialty classification
Active Colorado DORA license confirmed
Active Medicare billing confirmed
Single address source (NPPES)
Limited carrier network presence
3 networks across 2 carriers
Disclaimer: This analysis uses publicly available federal and state data sources. It does not constitute a determination of provider status or network participation. Contact the provider or health plan directly to verify current status.