Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 17461 | CO |
NPI | 1023052891 |
---|---|
Provider Name | Carl Robert Dahl |
First Address | Lakewood, CO 80215-3812 |
Second Address | Wheat Ridge, CO 80033-4355 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 18/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01174614 | (05) | CO |
100010928 | RAILROAD MEDICARE (01) | CO |
D23278 | (02) | CO |