Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 8800 | CO |
NPI | 1063614006 |
---|---|
Provider Name | Dr. Colin Gibson |
First Address | Westminster, CO 80234-2708 |
Second Address | Westminster, CO 80234-2708 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1063437937 | NPI TYPE 2 FOR 1ST IMPRES (01) | CO |