Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 38443 | CO |
NPI | 1093723231 |
---|---|
Provider Name | Dr. Meriam Pacan Izon |
First Address | Fort Collins, CO 80528-3403 |
Second Address | Fort Collins, CO 80528-3403 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2006 |
Last Update Date | 27/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
14183081 | (05) | CO |
P00645402 | RAILROAD MEDICARE (01) | CO |