Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 39549 | CO |
NPI | 1003885393 |
---|---|
Provider Name | Andre L Reed |
First Address | Englewood, CO 80110-2432 |
Second Address | Denver, CO 80210-5851 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2006 |
Last Update Date | 22/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
040016226 | RAILROAD MEDICARE (01) | CO |
86685236 | (05) | CO |