Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | DR.0059905 | CO |
NPI | 1053686253 |
---|---|
Provider Name | Austin Poole |
First Address | Royal Oak, MI 48067-3341 |
Second Address | Boulder, CO 80303-1385 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2012 |
Last Update Date | 15/03/2018 |