Organization
BOULDER FAMILY MEDICINE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES TAWA M.D. (MANAGER/OWNER)
(303) 996-6923
Entity
Organization
Contact information
Practice address
1000 ALPINE AVE, STE 260, BOULDER, CO 80304-3406
(303) 996-6923
(303) 996-6926
Mailing address
1000 ALPINE AVE, STE 260, BOULDER, CO 80304-3406
(303) 996-6923
(303) 996-6926
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
28790
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01287903
—
CO
01
—
C802261
MEDICARE
CO
Enumeration date
08/29/2007
Last updated
11/16/2007
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