Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 25075 | CO |
N | 111NI0900X | Internist | 25075 | CO |
Y | 207RG0300X | Geriatric Medicine | 25075 | CO |
NPI | 1003923194 |
---|---|
Provider Name | Mr. Ivan Benjamin Geller |
First Address | Wheat Ridge, CO 80033-4880 |
Second Address | Wheat Ridge, CO 80033-4880 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2006 |
Last Update Date | 16/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01250752 | (05) | CO |
CU0583 | RRW MEDICARE (01) | CO |
D24569 | (02) |