Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 31556 | CO |
NPI | 1083689376 |
---|---|
Provider Name | Dr. Kenneth Max Richards |
First Address | Greeley, CO 80631-5209 |
Second Address | Greeley, CO 80631-4500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2006 |
Last Update Date | 17/03/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
68738030 | (05) | CO |
H54260 | (02) | CO |