Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | DE60301991 | WA |
Y | 1223G0001X | General Practice | DE60301991 | WA |
Y | 213EG0000X | General Practice | DE60301991 | WA |
N | 1223P0700X | Prosthodontist | DE60301991 | WA |
NPI | 1225388606 |
---|---|
Provider Name | Dr. Blake Spencer Barney |
First Address | Fort Collins, CO 80524 |
Second Address | Fort Collins, CO 80524 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2012 |
Last Update Date | 21/01/2015 |