Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 35887 | CO |
Y | 207XS0117X | Orthopaedic Spine Surgeon | 35887 | CO |
NPI | 1104889591 |
---|---|
Provider Name | Douglas C Wong |
First Address | Golden, CO 80401-9541 |
Second Address | Golden, CO 80401-9541 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2006 |
Last Update Date | 14/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01358878 | (05) | CO |
G49982 | (02) |