Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 2688 | CO |
NPI | 1154455939 |
---|---|
Provider Name | Ivo F Waerlop |
First Address | Dillon, CO 80435 |
Second Address | Dillon, CO 80435 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2007 |
Last Update Date | 08/07/2007 |