Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | DR-48333 | CO |
NPI | 1629306006 |
---|---|
Provider Name | Dr. Edmon Khoury |
First Address | Castle Rock, CO 80108-8837 |
Second Address | Lone Tree, CO 80124-3191 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/11/2009 |
Last Update Date | 24/11/2009 |