Individual
JIE MAO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1100 BALSAM AVE, RADIOLOGY, BOULDER, CO 80304-3404
(303) 440-2273
Mailing address
42 GARDEN CTR, BROOMFIELD, CO 80020-1730
(303) 465-0401
(303) 438-1351
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
41795
CO
2085R0204X
Vascular & Interventional Radiology Physician
DR.0041795
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
96073721
—
CO
Enumeration date
08/30/2005
Last updated
03/15/2021
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