Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | DR.0036397 | CO |
NPI | 1033196316 |
---|---|
Provider Name | Kenneth Washburn |
First Address | Grand Junction, CO 81506-8818 |
Second Address | Grand Junction, CO 81506-8818 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2005 |
Last Update Date | 10/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
47478551 | (05) | CO |
A03495 | (02) |