Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 7467 | CO |
NPI | 1023084423 |
---|---|
Provider Name | Dr. James C Braun |
First Address | Fort Collins, CO 80525-3384 |
Second Address | Fort Collins, CO 80525-1195 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2006 |
Last Update Date | 08/07/2007 |