Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 49658 | MN |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | MD60286714 | WA |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | ME103522 | FL |
Y | 207YS0123X | Facial Plastic Surgeon | DR.0053492 | CO |
N | 207YS0123X | Facial Plastic Surgeon | MD60286714 | WA |
NPI | 1104041326 |
---|---|
Provider Name | David Jonas Archibald |
First Address | Castle Rock, CO 80109-8406 |
Second Address | Castle Rock, CO 80109-8406 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2007 |
Last Update Date | 04/12/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003610900 | (05) | FL |
14F11 | BLUE CROSS BLUE SHIELD (01) | FL |
205455000 | (05) | MN |
32778856 | (05) | CO |