Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 5141 | CO |
NPI | 1013051689 |
---|---|
Provider Name | Dr. Joseph P Zufall |
First Address | Pueblo, CO 81004-3553 |
Second Address | Pueblo, CO 81004-3553 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02051415 | (05) | CO |
U 09111 | (02) | CO |