Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 0056872 | CO |
N | 208800000X | Urologist | ME101754 | FL |
NPI | 1003090382 |
---|---|
Provider Name | Dr. John William Tillett |
First Address | Denver, CO 80211-5222 |
Second Address | Denver, CO 80211-5222 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2007 |
Last Update Date | 06/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0028405-00 | (05) | FL |
10Y538 | HEALTHY KIDS (01) | FL |
149XJ | BCBS OF FL (01) | FL |
1976114 | CIGNA (01) | FL |
342733 | AVMED (01) | FL |
9377632 | AETNA (01) | FL |
P01194994 | RAILROAD MCR (01) | FL |
P1002313 | FREEDOM HEALTH (01) | FL |