Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 8684 | CO |
NPI | 1003952516 |
---|---|
Provider Name | Dr. Brian Frutchey |
First Address | Louisville, CO 80027-2417 |
Second Address | Louisville, CO 80027-2417 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2007 |
Last Update Date | 08/07/2007 |