Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QG0300X | Family Doctor - Geriatric Medicine | 2OA8201 | CA |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 44663 | CO |
NPI | 1194703926 |
---|---|
Provider Name | Dr. Julie Ann Devita-Bailey |
First Address | Fort Collins, CO 80524-4007 |
Second Address | Fort Collins, CO 80524-4007 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2006 |
Last Update Date | 12/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
026776 | KAISER COMMERCIAL NUMBER (01) | CO |
53752244 | (05) | CO |
I48573 | (02) | CO |
P00389920 | RAILROAD MEDICARE (01) | CO |