Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | MD053744L | PA |
NPI | 1013987262 |
---|---|
Provider Name | Dr. Kevin Deweber |
First Address | Fort Carson, CO 80913-4603 |
Second Address | Fort Carson, CO 80913-4604 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2006 |
Last Update Date | 08/07/2007 |