Provider Demographics
NPI:1346537370
Name:GARG, ANEESH (DO)
Entity type:Individual
Prefix:DR
First Name:ANEESH
Middle Name:
Last Name:GARG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1790 30TH ST STE 270
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1085
Mailing Address - Country:US
Mailing Address - Phone:303-997-1733
Mailing Address - Fax:
Practice Address - Street 1:1790 30TH ST STE 270
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1085
Practice Address - Country:US
Practice Address - Phone:303-997-1733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.139147207RS0010X
TN4058207RS0010X
CODR.0069417207RS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine