Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 41940 | CO |
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | G16329 | CA |
NPI | 1063609535 |
---|---|
Provider Name | Dr. Marshall Jeffrey Handleman |
First Address | Woodland Park, CO 80863-8824 |
Second Address | Woodland Park, CO 80863-8824 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2007 |
Last Update Date | 28/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A90421 | (02) | CA |