Individual
BRADLEY D FANESTIL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4801 RIVERBEND RD STE 120B, BOULDER, CO 80301-2613
(303) 415-8615
(303) 293-0628
Mailing address
5450 WESTERN AVE, BOULDER, CO 80301-2709
(303) 415-4250
(303) 440-9629
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
DR.0031874
CO
Other
Enumeration date
02/01/2007
Last updated
05/10/2019
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