Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 15802 | CO |
NPI | 1285745695 |
---|---|
Provider Name | Dr. Alfred Nathan Carr |
First Address | Longmont, CO 80501-3183 |
Second Address | Longmont, CO 80501-3183 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 22/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01158021 | (05) | CO |
D22921 | (02) | CO |