Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 50150 | CO |
N | 207QS0010X | Family Doctor - Sports Medicine | 0050150 | CO |
NPI | 1104141670 |
---|---|
Provider Name | Eric Traister |
First Address | Longmont, CO 80501-3215 |
Second Address | Longmont, CO 80501-3215 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2010 |
Last Update Date | 27/12/2017 |