Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | CHR-6140 | CO |
NPI | 1194913384 |
---|---|
Provider Name | Dr. Jared Wayne Allomong |
First Address | Longmont, CO 80501-2462 |
Second Address | Longmont, CO 80501-2462 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2007 |
Last Update Date | 12/10/2007 |