Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RR0500X | Rheumatology | 21258 | NE |
Y | 207RR0500X | Rheumatology | 25100 | CO |
N | 207RR0500X | Rheumatology | 3714A | WY |
NPI | 1023109923 |
---|---|
Provider Name | Fred H Meyer |
First Address | Fort Collins, CO 80521-2147 |
Second Address | Fort Collins, CO 80521-2147 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 07/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01251008 | (05) | CO |
D24574 | (02) |