Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 20521 | CO |
N | 207ND0101X | MOHS-Micrographic Surgeon | 20521 | CO |
NPI | 1184699159 |
---|---|
Provider Name | John R Steinbaugh |
First Address | Boulder, CO 80304-0726 |
Second Address | Boulder, CO 80304-1825 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2006 |
Last Update Date | 28/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01205210 | (05) | CO |
C81522 | (02) | CO |