Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 29594 | CO |
NPI | 1164545232 |
---|---|
Provider Name | Dr. Milton Hammerly |
First Address | Englewood, CO 80113-2911 |
Second Address | Englewood, CO 80113-2911 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
29594 | COLORADO LICENSE (01) | CO |
BH1238674 | DEA (01) | |
E32946 | (02) |