Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 22742 | CO |
N | 111NI0900X | Internist | 22742 | CO |
Y | 207RA0201X | Internist - Allergy & Immunology | 22742 | CO |
NPI | 1861404220 |
---|---|
Provider Name | Dr. Robert Scott Pace |
First Address | Longmont, CO 80501-6971 |
Second Address | Longmont, CO 80501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2006 |
Last Update Date | 01/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01227420 | (05) | CO |
E69038 | (02) | CO |