Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | DR.0066038 | CO |
NPI | 1285645135 |
---|---|
Provider Name | Diane Straub |
First Address | Aurora, CO 80042-0429 |
Second Address | Aurora, CO 80011-6714 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2006 |
Last Update Date | 12/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
265177700 | (05) | DC |
51548 | BLUE CROSS BLUE SHIELD (01) | FL |
H32661 | (02) | FL |