Organization
TAKE TWO HEALTH PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LETO QUARLES MD (PHYSICIAN CEO)
(303) 557-2250
Entity
Organization
Contact information
Practice address
2503 WALNUT ST STE 200, BOULDER, CO 80302-5745
(303) 557-2250
(303) 325-7688
Mailing address
417 PEARL ST, BOULDER, CO 80302-4930
13035026241
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
DR-45461
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
57820511
—
CO
Enumeration date
08/07/2017
Last updated
08/07/2017
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