Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | DR.0064366 | CO |
NPI | 1245645951 |
---|---|
Provider Name | Jeffrey A Ebel |
First Address | Fort Collins, CO 80525-9718 |
Second Address | Fort Collins, CO 80525-9718 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2014 |
Last Update Date | 02/09/2021 |