Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | PA0003735 | CO |
NPI | 1003257742 |
---|---|
Provider Name | Beth Poeppelman |
First Address | Highlands Ranch, CO 80129-2321 |
Second Address | Highlands Ranch, CO 80129-2321 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2013 |
Last Update Date | 11/05/2018 |