Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 41545 | CO |
NPI | 1013902352 |
---|---|
Provider Name | John Tobey |
First Address | Boulder, CO 80303-4284 |
Second Address | Boulder, CO 80303-4284 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2005 |
Last Update Date | 04/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
53177321 | (05) | CO |