Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | 30767 | CO |
NPI | 1326086596 |
---|---|
Provider Name | Dr. Thomas G Mordick II |
First Address | Denver, CO 80218-1128 |
Second Address | Denver, CO 80218-1128 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2006 |
Last Update Date | 30/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01306760 | (05) | CO |
04013215 | (05) | CO |