Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 02078038 | CO |
NPI | 1548342629 |
---|---|
Provider Name | Dr. Barry S Keogh |
First Address | Aurora, CO 80014 |
Second Address | Aurora, CO 80014 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02078038 | (05) | CO |