Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208D00000X | General Practice Physician | 39597 | CO |
NPI | 1003955279 |
---|---|
Provider Name | Cathy O'neil |
First Address | Centennial, CO 80112-3462 |
Second Address | Longmont, CO 80501-3178 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2007 |
Last Update Date | 26/06/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
83509542 | (05) | CO |
G19445 | (02) | CO |