Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 14326 | CO |
NPI | 1003829300 |
---|---|
Provider Name | Jamieson D Kennedy |
First Address | Colorado Springs, CO 80904 |
Second Address | Colorado Springs, CO 80904 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2006 |
Last Update Date | 20/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01143262 | (05) | CO |
D22631 | (02) |