Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YS0123X | Facial Plastic Surgeon | DR50123 | CO |
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 50123 | CO |
NPI | 1578783395 |
---|---|
Provider Name | Dr. Keith M Ladner |
First Address | Denver, CO 80246-1226 |
Second Address | Denver, CO 80246-1226 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2007 |
Last Update Date | 17/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002232900 | (05) | FL |
022360 | KAISER COMMERCIAL NUMBER (01) | CO |
149KK | BLUE CROSS BLUE SHIELD (01) | FL |
64138224 | (05) | CO |