Individual
JOSEPH JOHN NISSIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2101 KEN PRATT BLVD STE 104, LONGMONT, CO 80501-6568
(303) 415-4157
(303) 776-3109
Mailing address
5450 WESTERN AVE, SUITE B, BOULDER, CO 80301-2709
(303) 415-4157
(303) 776-3109
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
DR.0027222
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04005930
—
CO
01
—
P00987579
MEDICARE RAILROAD
CO
Enumeration date
10/17/2006
Last updated
07/21/2022
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