Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | DEN.00204717 | CO |
Y | 213EG0000X | General Practice | DEN.00204717 | CO |
NPI | 1003487125 |
---|---|
Provider Name | Dr. Luke Vernon |
First Address | Boulder, CO 80301-1142 |
Second Address | Boulder, CO 80301-1142 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2021 |
Last Update Date | 09/07/2021 |