Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 20606 | CO |
NPI | 1013990365 |
---|---|
Provider Name | John S Harvey |
First Address | Fort Collins, CO 80525-9718 |
Second Address | Fort Collins, CO 80525-9718 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2005 |
Last Update Date | 20/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01206069 | (05) | CO |
D23810 | (02) |