Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 42490 | CO |
N | 207NS0135X | Procedural Dermatology | 42490 | CO |
NPI | 1023000692 |
---|---|
Provider Name | John Christopher Fueston |
First Address | Longmont, CO 80501-1716 |
Second Address | Longmont, CO 80501-1716 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2005 |
Last Update Date | 11/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I20188 | (02) | CO |