Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 38249 | CO |
N | 207P00000X | Emergency Physician | MD2010-0108 | NM |
NPI | 1013020460 |
---|---|
Provider Name | Charles Eaton Page |
First Address | Farmington, NM 87499-6210 |
Second Address | Durango, CO 81301-8296 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2006 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
42682274 | (05) | CO |
89375751 | (05) | NM |
H81500 | (02) | CO |
P00290341 | RAILROAD MEDICARE PIN (01) | CO |