Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | DR.0055346 | CO |
N | 207U00000X | Nuclear Medicine Specialist | MD60551342 | WA |
NPI | 1396970562 |
---|---|
Provider Name | Dr. Bradley William Fehrenbach |
First Address | Lakewood, CO 80401-3267 |
Second Address | Lakewood, CO 80401-3267 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2009 |
Last Update Date | 29/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2044583 | (05) | WA |
500688593 | (05) | OR |