Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | 4092 | CO |
NPI | 1356561211 |
---|---|
Provider Name | Eric M Young |
First Address | Pueblo, CO 81004-2005 |
Second Address | Pueblo, CO 81004-2005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U5661 | (02) | CO |