Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | DR.0058799 | CO |
N | 207RR0500X | Rheumatology | OS017698 | PA |
NPI | 1104147453 |
---|---|
Provider Name | David P Theis |
First Address | Colorado Springs, CO 80920 |
Second Address | Colorado Springs, CO 80920-1056 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2010 |
Last Update Date | 08/08/2017 |