Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213EP1101X | Primary Podiatric Medicine | POD.0000350 | CO |
Y | 213ES0103X | Foot & Ankle Surgery | POD.0000350 | CO |
NPI | 1275577389 |
---|---|
Provider Name | Mr. James C Anderson |
First Address | Fort Collins, CO 80524-4366 |
Second Address | Fort Collins, CO 80524-4366 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2006 |
Last Update Date | 12/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01003508 | (05) | CO |
113904500 | (05) | WY |