Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 37311 | CO |
NPI | 1003943051 |
---|---|
Provider Name | Dr. Lisa D Whitesides |
First Address | Denver, CO 80247-1314 |
Second Address | Denver, CO 80247-5104 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2007 |
Last Update Date | 17/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
012428 | KAISER-COMMERCIAL NUMBER (01) | |
96278714 | (05) | CO |
H25117 | (02) | CO |