Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 298 | CO |
N | 2081S0010X | Sports Medicine | 298 | CO |
N | 213ES0000X | Sports Medicine | 298 | CO |
N | 213ES0103X | Foot & Ankle Surgery | 298 | CO |
NPI | 1114907482 |
---|---|
Provider Name | Dr. Edward K Raczka |
First Address | Denver, CO 80210-5073 |
Second Address | Denver, CO 80210-5073 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2006 |
Last Update Date | 01/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01002989 | (05) | CO |
55653 | (02) | CO |
7047 | BC/BS PROVIDER # (01) | CO |
U17831 | (02) | CO |