Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 43687 | CO |
N | 207QG0300X | Family Doctor - Geriatric Medicine | G1754 | TX |
NPI | 1366405029 |
---|---|
Provider Name | Keith L Rapp |
First Address | Avon, CO 81620-4330 |
Second Address | Avon, CO 81620 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2006 |
Last Update Date | 14/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
123348802 | (05) | TX |
B25783 | (02) | TX |