Basic Information
| Provider Information | |||||||||
| NPI: | 1609985233 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SNOW | ||||||||
| FirstName: | TARA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2594 TRAILRIDGE DR E | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800263186 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034497740 | ||||||||
| FaxNumber: | 3036045393 | ||||||||
| Practice Location | |||||||||
| Address1: | 4747 ARAPAHOE AVE | ||||||||
| Address2: | |||||||||
| City: | BOULDER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 803031131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034157610 | ||||||||
| FaxNumber: | 3034157618 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2006 | ||||||||
| LastUpdateDate: | 01/04/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 42562 | CO | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | A99406 | CA | N | Allopathic & Osteopathic Physicians | Hospitalist | 207RH0002X | DR.0042562 | CO | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hospice and Palliative Medicine |
ID Information
| ID | Type | State | Issuer | Description | 27270246 | 05 | CO | MEDICAID |