Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | DEN-10144 | CO |
Y | 213EG0000X | General Practice | DEN-10144 | CO |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 2901020070 | MI |
NPI | 1033349774 |
---|---|
Provider Name | Dr. Matthew Renner Wimmer |
First Address | Centennial, CO 80121 |
Second Address | Centennial, CO 80121 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2009 |
Last Update Date | 18/06/2012 |