Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | DR.0061795 | CO |
NPI | 1336585942 |
---|---|
Provider Name | Christopher Stockburger |
First Address | Fort Collins, CO 80525-9718 |
Second Address | Fort Collins, CO 80525-9718 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2013 |
Last Update Date | 16/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
9000174169 | (05) | CO |