Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 26131 | CO |
NPI | 1043248966 |
---|---|
Provider Name | Allan Carl Koenig |
First Address | Thornton, CO 80233-1657 |
Second Address | Thornton, CO 80233-1657 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2006 |
Last Update Date | 28/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D43460 | (02) | CO |