Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207ND0101X | MOHS-Micrographic Surgeon | 27691 | CO |
N | 207ND0900X | Dermatopathologist | 27691 | CO |
N | 207NS0135X | Procedural Dermatology | 27691 | CO |
NPI | 1326074774 |
---|---|
Provider Name | Bruce W Kornfeld |
First Address | Fort Collins, CO 80526-1849 |
Second Address | Fort Collins, CO 80526-1849 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01276914 | (05) | CO |
E04819 | (02) | CO |