Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 29619 | CO |
Y | 208600000X | Surgeon | 29619 | CO |
N | 2082S0105X | Plastic Hand Surgeon | 29619 | CO |
NPI | 1013949288 |
---|---|
Provider Name | Charles Willis Kessler |
First Address | Pueblo, CO 81005-1212 |
Second Address | Pueblo, CO 81005-1212 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 25/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E21608 | (02) |