Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2081P2900X | Pain Medicine | 48088 | CO |
NPI | 1154584266 |
---|---|
Provider Name | Dr. Matthew David Pouliot |
First Address | Fort Collins, CO 80525-4333 |
Second Address | Fort Collins, CO 80525-4333 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2008 |
Last Update Date | 26/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10026360700 | (05) | NE |
132413600 | (05) | WY |
53107578 | (05) | CO |