Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 202860 | CO |
NPI | 1548689029 |
---|---|
Provider Name | James Brandon Mathias Luter |
First Address | Boulder, CO 80301-1800 |
Second Address | Boulder, CO 80301-1800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2014 |
Last Update Date | 11/06/2021 |