Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 39382 | CO |
NPI | 1154423291 |
---|---|
Provider Name | Dr. Jeffrey Ronald Raval |
First Address | Denver, CO 80210-7009 |
Second Address | Denver, CO 80210-7009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2006 |
Last Update Date | 20/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
12885533 | (05) | CO |
39382 | STATE (01) | CO |
BR5392179 | DEA (01) | CO |
H17666 | (02) | CO |