Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 43475 | CO |
NPI | 1053395624 |
---|---|
Provider Name | Dr. Michael Brian Maris |
First Address | Denver, CO 80237-3486 |
Second Address | Denver, CO 80218-1238 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2005 |
Last Update Date | 01/10/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10025893500 | (05) | NE |
123706300 | (05) | WY |
200443060B | (05) | KS |
25326741 | (05) | CO |
33784007 | (05) | NM |
H45358 | (02) |