Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 571 | CO |
NPI | 1184648750 |
---|---|
Provider Name | Jonathon Dormish |
First Address | Aurora, CO 80012-6141 |
Second Address | Aurora, CO 80012-6141 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U75409 | (02) | CO |