Basic Information
Provider Information
NPI: 1245448984
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DOLBEARE
FirstName: DIRK
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4740 PEARL PKWY
Address2: STE 200
City: BOULDER
State: CO
PostalCode: 803013080
CountryCode: US
TelephoneNumber: 3034492730
FaxNumber:  
Practice Location
Address1: 4740 PEARL PKWY STE 200
Address2:  
City: BOULDER
State: CO
PostalCode: 803013080
CountryCode: US
TelephoneNumber: 3034492730
FaxNumber: 3034495821
Other Information
ProviderEnumerationDate: 05/18/2007
LastUpdateDate: 07/21/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207X00000X47523COY Allopathic & Osteopathic PhysiciansOrthopaedic Surgery 

No ID Information.


Home