Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | DR.0045851 | CO |
N | 207Q00000X | Family Doctor | DO1926 | NV |
N | 207Q00000X | Family Doctor | DR.0045851 | CO |
N | 207QA0505X | Family Doctor - Adult Medicine | G8547 | TX |
NPI | 1083604045 |
---|---|
Provider Name | Dr. Christopher Robert Mcnulty |
First Address | Colorado Springs, CO 80903-1604 |
Second Address | Colorado Springs, CO 80907 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2005 |
Last Update Date | 31/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1083604045 | SMA MEDICAID (01) | NV |
9000126932 | (05) | CO |
V109653 | SMA MEDICARE (01) | NV |