Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 43062 | CO |
NPI | 1285629741 |
---|---|
Provider Name | Dr. Kelly Peter Letourneau |
First Address | Lakewood, CO 80232-5415 |
Second Address | Lakewood, CO 80232-5415 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2005 |
Last Update Date | 08/07/2007 |