Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 50369 | CO |
N | 207QS0010X | Family Doctor - Sports Medicine | 50369 | CO |
NPI | 1114077278 |
---|---|
Provider Name | Jason Matthew Tarno |
First Address | Colorado Springs, CO 80907-6819 |
Second Address | Colorado Springs, CO 80907 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2007 |
Last Update Date | 09/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
51705729 | (05) | CO |
G94248 | (02) | CO |