Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XS0117X | Orthopaedic Spine Surgeon | 23258 | CO |
NPI | 1356326300 |
---|---|
Provider Name | Kenneth Booth Kurica |
First Address | Colorado Springs, CO 80918-4062 |
Second Address | Colorado Springs, CO 80918-4062 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2005 |
Last Update Date | 12/08/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01232586 | (05) | CO |