Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | CO |
NPI | 1013149566 |
---|---|
Provider Name | Joseph Beau Carter |
First Address | Denver, CO 80237-2067 |
Second Address | Denver, CO 80237-2067 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2009 |
Last Update Date | 18/08/2009 |