Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | DR.0036373 | CO |
NPI | 1336195601 |
---|---|
Provider Name | Dr. Thomas R Sachtleben |
First Address | Fort Collins, CO 80525-9718 |
Second Address | Fort Collins, CO 80525-9718 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2006 |
Last Update Date | 16/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
87501856 | (05) | CO |
P00621706 | RR MEDICARE (01) | CO |