Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | DR.0058821 | CO |
NPI | 1053317578 |
---|---|
Provider Name | Miss Ellen Ablog Dy |
First Address | Glenwood Springs, CO 81601-4275 |
Second Address | Glenwood Springs, CO 81601-4275 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2005 |
Last Update Date | 16/11/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0139659 | (05) | IA |
E88639 | (02) | IA |