Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0201X | Pediatric Allergist | 19134 | CO |
NPI | 1003906785 |
---|---|
Provider Name | John Roger Hollister |
First Address | Aurora, CO 80042-0429 |
Second Address | Aurora, CO 80045-7106 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 13/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01191345 | (05) | CO |