Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 48208 | CO |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 48208 | CO |
NPI | 1023123957 |
---|---|
Provider Name | Jonathan S. Gallen |
First Address | Denver, CO 80209-4941 |
Second Address | Denver, CO 80211-3644 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2006 |
Last Update Date | 19/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D45399 | (02) | CO |