Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 170100000X | Medical Geneticist |
NPI | 1548872286 |
---|---|
Provider Name | Dr. Stephen John Wicks |
First Address | Denver, CO 80204-1106 |
Second Address | Aurora, CO 80045-7112 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2020 |
Last Update Date | 22/08/2020 |