Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 40997 | CO |
NPI | 1023177573 |
---|---|
Provider Name | Dr. Jagadish Boggavarapu |
First Address | Lakewood, CO 80226-3144 |
Second Address | Lakewood, CO 80226-3144 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2006 |
Last Update Date | 15/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01607251 | (05) | CO |
G15537 | (02) | CO |