Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0129X | Vascular Surgeon | 29590 | CO |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 29590 | CO |
N | 208G00000X | Cardiothoracic Vascular Surgeon | 5495A | WY |
NPI | 1043208259 |
---|---|
Provider Name | Dr. Mark D Guadagnoli |
First Address | Loveland, CO 80538-9004 |
Second Address | Loveland, CO 80538-9004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2005 |
Last Update Date | 01/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01295906 | (05) | CO |
1043208259 | (05) | NE |
111738600 | (05) | WY |
E21607 | (02) | CO |
P00970371 | RAILROAD MEDICARE (01) | CO |