Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207KA0200X | Allergist | 024632 | LA |
Y | 207KA0200X | Allergist | 43625 | CO |
NPI | 1679573588 |
---|---|
Provider Name | Daniel Fletcher Soteres |
First Address | Colorado Springs, CO 80907-6231 |
Second Address | Colorado Springs, CO 80907-6231 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2005 |
Last Update Date | 24/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
56536836 | (05) | CO |
57393 | (05) | LA |
H24975 | (02) |