Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 29026 | CO |
NPI | 1124442017 |
---|---|
Provider Name | Dr. Chandra Punch |
First Address | Fort Carson, CO 80913 |
Second Address | Ft Carson, CO 80913 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2014 |
Last Update Date | 03/01/2020 |