Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 104655 | CO |
NPI | 1003831199 |
---|---|
Provider Name | Jeffrey Robert Stump |
First Address | Frisco, CO 80443-0645 |
Second Address | Frisco, CO 80443-0645 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 08/07/2007 |