Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 05489 | CO |
NPI | 1245238377 |
---|---|
Provider Name | Jeffery M White |
First Address | Aurora, CO 80012-6141 |
Second Address | Aurora, CO 80012-6141 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02054898 | (05) | CO |
T60703 | (02) | CO |