Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0200X | Radiology | 1473 | CO |
Y | 213ER0200X | Radiology | 1473 | CO |
NPI | 1558660555 |
---|---|
Provider Name | Dr. Randolph F Baca |
First Address | Arvada, CO 80003-0922 |
Second Address | Arvada, CO 80003-0922 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2011 |
Last Update Date | 16/03/2011 |