Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | DR.0022508 | CO |
NPI | 1013917756 |
---|---|
Provider Name | Alida Rae Near |
First Address | Englewood, CO 80113-2638 |
Second Address | Englewood, CO 80113-2702 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2005 |
Last Update Date | 11/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01225085 | (05) | CO |
E94959 | (02) | CO |