Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | DR0053632 | CO |
Y | 207L00000X | Anesthesiologist | MED-PHYS-LIC-60262 | MT |
N | 207R00000X | Internist | MT196857 | PA |
N | 111NI0900X | Internist | MT196857 | PA |
NPI | 1013234665 |
---|---|
Provider Name | August Denicco |
First Address | Lakewood, CO 80228-1527 |
Second Address | Missoula, MT 59808-1548 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2010 |
Last Update Date | 17/03/2018 |