Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 1896 | CO |
Y | 103T00000X | Psychologist | 1896 | CO |
NPI | 1003969379 |
---|---|
Provider Name | Dr. Ronald Keene Hueftle |
First Address | Lakewood, CO 80401 |
Second Address | Lakewood, CO 80401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2007 |
Last Update Date | 08/07/2007 |