Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 44132 | CO |
NPI | 1003001256 |
---|---|
Provider Name | Jennifer A Caragol |
First Address | Evans, CO 80620-1011 |
Second Address | Evans, CO 80620-1011 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2007 |
Last Update Date | 11/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
19535279 | (05) | CO |