Provider Demographics
NPI:1538128434
Name:MORITZ, CARL ALBERT JR (MD)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:ALBERT
Last Name:MORITZ
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2760 29TH ST
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301
Mailing Address - Country:US
Mailing Address - Phone:303-444-6400
Mailing Address - Fax:303-444-6465
Practice Address - Street 1:2760 29TH ST
Practice Address - Street 2:SUITE 2B
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301
Practice Address - Country:US
Practice Address - Phone:303-444-6400
Practice Address - Fax:303-444-6465
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO26399207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01263995Medicaid
D24794Medicare UPIN