Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 39740 | CO |
NPI | 1043236961 |
---|---|
Provider Name | Jesus E Carale |
First Address | La Junta, CO 81050-2728 |
Second Address | La Junta, CO 81050-2728 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2006 |
Last Update Date | 18/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
07370342 | (05) | CO |
CAA54671 | BLUE CROSS (01) | CO |
H46515 | (02) | CO |
P00175695 | RAILROAD MEDICARE (01) | CO |