Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2082S0105X | Plastic Hand Surgeon | 31474 | CO |
NPI | 1538143235 |
---|---|
Provider Name | Dr. Conrad J Tirre |
First Address | Denver, CO 80210-5847 |
Second Address | Denver, CO 80210-5847 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2005 |
Last Update Date | 04/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01314749 | (05) | CO |
F90191 | (02) | CO |