Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | 44516 | CO |
NPI | 1699851394 |
---|---|
Provider Name | Dr. Ian Gerald Dresner |
First Address | Glenwood Springs, CO 81601-4288 |
Second Address | Glenwood Springs, CO 81601-4288 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2006 |
Last Update Date | 29/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
55589031 | (05) | CO |
A77822 | (02) | |
A77822 | (02) | OH |