Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 820 | CO |
NPI | 1053524124 |
---|---|
Provider Name | Michael A. Colb |
First Address | Pueblo, CO 81008-1698 |
Second Address | Pueblo, CO 81008-1698 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2007 |
Last Update Date | 08/07/2007 |