Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 40526 | CO |
NPI | 1134112345 |
---|---|
Provider Name | Dr. Christopher Kelly Bynum |
First Address | Montrose, CO 81401-4226 |
Second Address | Montrose, CO 81401-4226 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2005 |
Last Update Date | 08/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
62858521 | (05) | CO |
H52559 | (02) | CO |