Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NN0400X | Neurology | 06903 | CO |
NPI | 1659347227 |
---|---|
Provider Name | Dr. Jesse Sutton Hironymous |
First Address | Colorado Springs, CO 80909-4312 |
Second Address | Colorado Springs, CO 80909-4312 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2006 |
Last Update Date | 04/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U76435 | (02) |