Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | 47733 | CO |
NPI | 1063514495 |
---|---|
Provider Name | Dr. Kane Librum Anderson |
First Address | Durango, CO 81301-7306 |
Second Address | Durango, CO 81301-7306 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2006 |
Last Update Date | 27/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
305752 | MEDICARE PTAN (01) | CO |