Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | CPO1908 | DE |
N | 222Z00000X | Podiatrist | CPO1908 | DE |
Y | 224P00000X | Prosthetist | CPO1908 | DE |
NPI | 1104986819 |
---|---|
Provider Name | Mr. Christian Blake Bailey |
First Address | Denver, CO 80246-8008 |
Second Address | Denver, CO 80246-8008 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2006 |
Last Update Date | 12/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
38833051 | (05) | CO |