Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 31919 | CO |
N | 2081P2900X | Pain Medicine | 31919 | CO |
NPI | 1124107909 |
---|---|
Provider Name | Mr. Jeffrey Kesten |
First Address | Golden, CO 80401-3600 |
Second Address | Golden, CO 80401-3600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2006 |
Last Update Date | 22/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01319193 | (05) | CO |
F50711 | (02) |