Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 30373 | CO |
Y | 207Q00000X | Family Doctor | 30373 | CO |
NPI | 1528124369 |
---|---|
Provider Name | Dr. John R Willard |
First Address | Centennial, CO 80112-4028 |
Second Address | Centennial, CO 80112-4028 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2006 |
Last Update Date | 22/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01303734 | (05) | CO |
E95762 | (02) | CO |