Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 12740 | CO |
NPI | 1043537251 |
---|---|
Provider Name | Dr. William G Mehos |
First Address | Salida, CO 81201-1728 |
Second Address | Salida, CO 81201-1728 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2010 |
Last Update Date | 27/04/2010 |