Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 35186 | CO |
NPI | 1225100324 |
---|---|
Provider Name | Dr. Susan Elizabeth Damon |
First Address | Centennial, CO 80122-2526 |
Second Address | Centennial, CO 80112-6248 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2006 |
Last Update Date | 07/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01351865 | (05) | CO |