Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 43741 | CO |
NPI | 1053426643 |
---|---|
Provider Name | Edward H Maa |
First Address | Denver, CO 80204-4507 |
Second Address | Denver, CO 80204-4507 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I52005 | (02) |