Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 63617 | CO |
NPI | 1659362549 |
---|---|
Provider Name | Dr. Mary Beth Deering |
First Address | Grand Junction, CO 81505-6401 |
Second Address | Grand Junction, CO 81505-6401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2005 |
Last Update Date | 31/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
83131540 | (05) | CO |
I65155 | (02) | |
P00322762 | RAILROAD MEDICARE (01) | CO |