Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | ||
Y | 222Z00000X | Podiatrist |
NPI | 1073163671 |
---|---|
Provider Name | Bret Bostock |
First Address | Denver, CO 80237-3011 |
Second Address | Denver, CO 80237-3011 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2019 |
Last Update Date | 14/08/2020 |