Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223D0001X | Dental Public Health | 8471 | CO |
N | 1223G0001X | General Practice | 8471 | CO |
N | 213EG0000X | General Practice | 8471 | CO |
Y | 1223G0001X | General Practice | 8471CO | CO |
Y | 213EG0000X | General Practice | 8471CO | CO |
NPI | 1558360073 |
---|---|
Provider Name | Dr. Casey Lee Kochevar |
First Address | Longmont, CO 80501 |
Second Address | Longmont, CO 80501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2005 |
Last Update Date | 31/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
78271045 | (05) | CO |
96800241 | (05) | CO |