Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 48258 | CO |
N | 2086S0120X | Pediatric Surgery | MD2017-0745 | NM |
NPI | 1073650362 |
---|---|
Provider Name | Jonathan Roach |
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 | 30/01/2007 |
Last Update Date | 11/12/2017 |