Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 24552 | CO |
NPI | 1184695967 |
---|---|
Provider Name | Dr. Patrick Anthony Tellez |
First Address | Denver, CO 80206-4541 |
Second Address | Englewood, CO 80113-3611 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2006 |
Last Update Date | 18/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1184695967 | (05) | CO |