Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | 42446 | CO |
NPI | 1124011606 |
---|---|
Provider Name | Dr. Gary Ghiselli |
First Address | Greenwood Village, CO 80111-2583 |
Second Address | Greenwood Village, CO 80111-2583 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2005 |
Last Update Date | 14/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
107033250101 | IHC (01) | CO |
4019320001 | PALMETTO GBA (01) | |
841519664006 | RMHMO (01) | CO |
84151966413 | PACIFICARE (01) | CO |
GH669216 | BCBS (01) | CO |
H87784 | (02) | CO |