Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 41103 | CO |
NPI | 1285737668 |
---|---|
Provider Name | Jo Ann Douglas |
First Address | Lakewood, CO 80228-0113 |
Second Address | Lakewood, CO 80226-3946 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2006 |
Last Update Date | 01/08/2007 |