Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 57823 | AZ |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | DR.0064635 | CO |
NPI | 1528487600 |
---|---|
Provider Name | Jared Shoji Pate |
First Address | Aurora, CO 80042-0429 |
Second Address | Longmont, CO 80504-5311 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2014 |
Last Update Date | 28/08/2020 |