Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2081S0010X | Sports Medicine | AT.0001680 | CO |
N | 213ES0000X | Sports Medicine | AT.0001680 | CO |
NPI | 1245815612 |
---|---|
Provider Name | Mr. Charles Ernest Sedelmyer |
First Address | Usaf Academy, CO 80840-9599 |
Second Address | Usaf Academy, CO 80840-9599 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2021 |
Last Update Date | 18/03/2021 |