Basic Information
| Provider Information | |||||||||
| NPI: | 1811043409 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOSWORTH | ||||||||
| FirstName: | CORTNEY | ||||||||
| MiddleName: | RAY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 130 RAMPART WAY, STE 300B | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802306451 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033274700 | ||||||||
| FaxNumber: | 3033274711 | ||||||||
| Practice Location | |||||||||
| Address1: | 3550 LUTHERAN PKWY | ||||||||
| Address2: | BLDG 10 SUITE 200 | ||||||||
| City: | WHEAT RIDGE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800336017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7205362100 | ||||||||
| FaxNumber: | 7205362090 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2007 | ||||||||
| LastUpdateDate: | 11/17/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | 46927 | CO | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 1811043409 | 01 | CO | NPI | OTHER | 84485779 | 05 | CO | MEDICAID |