Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XS0106X | Orthopaedic Hand Surgeon | DR.0054213 | CO |
N | 208200000X | Surgeon | DR.0054213 | CO |
N | 208600000X | Surgeon | DR.0054213 | CO |
Y | 2082S0105X | Plastic Hand Surgeon | DR.0054213 | CO |
N | 2086S0105X | Surgery of the Hand | DR.0054213 | CO |
NPI | 1639312192 |
---|---|
Provider Name | Dr. Seth Tebockhorst |
First Address | Golden, CO 80401-2265 |
Second Address | Golden, CO 80401-2265 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2009 |
Last Update Date | 08/04/2021 |