Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0101X | MOHS-Micrographic Surgeon | DR-51006 | CO |
NPI | 1508049206 |
---|---|
Provider Name | Dr. Todd Charles Becker |
First Address | Boulder, CO 80301-1237 |
Second Address | Boulder, CO 80301-1237 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/12/2007 |
Last Update Date | 07/03/2016 |