Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 39345 | CO |
NPI | 1053448084 |
---|---|
Provider Name | Dr. Dustin R Ridout |
First Address | Denver, CO 80205-5437 |
Second Address | Denver, CO 80205-5437 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2007 |
Last Update Date | 26/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
012703 | KAISER-COMMERCIAL NUMBER (01) | |
32706537 | (05) | CO |
H33855 | (02) | CO |