Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 39385 | CO |
Y | 207QS0010X | Family Doctor - Sports Medicine | 39385 | CO |
NPI | 1003813999 |
---|---|
Provider Name | Dr. Tod Sweeney |
First Address | Arvada, CO 80004-3535 |
Second Address | Arvada, CO 80004-3535 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2005 |
Last Update Date | 25/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
50571737 | (05) | CO |
H60615 | (02) | CO |