Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 0015004 | CO |
Y | 213ES0000X | Sports Medicine | 0015004 | CO |
NPI | 1538738216 |
---|---|
Provider Name | Marcus J. Contreras |
First Address | Brush, CO 80723-2320 |
Second Address | Greeley, CO 80634-3651 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2021 |
Last Update Date | 17/06/2021 |