Organization
BOULDER PLASTIC SURGERY PROF LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BETHANY MASON (INSURANCE BILLING COORDINATOR)
(303) 558-5407
Entity
Organization
Contact information
Practice address
1215 SPRUCE ST STE 201, BOULDER, CO 80302-4839
(303) 443-2277
(303) 443-7124
Mailing address
1215 SPRUCE ST STE 201, BOULDER, CO 80302-4839
(303) 443-2277
(303) 443-7124
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DD7824
RAILROAD MEDICARE
CO
Enumeration date
06/09/2006
Last updated
12/02/2025
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