Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204E00000X | Oral & Maxillofacial Surgeon | 22517 | CO |
N | 204E00000X | Oral & Maxillofacial Surgeon | 34139 | MI |
Y | 2082S0105X | Plastic Hand Surgeon | 22517 | CO |
N | 2082S0105X | Plastic Hand Surgeon | 34139 | MI |
NPI | 1740494467 |
---|---|
Provider Name | Mr. Norman Philip Payea II |
First Address | Lakewood, CO 80215-4848 |
Second Address | Lakewood, CO 80215-4848 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2007 |
Last Update Date | 22/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01225176 | (05) | CO |
1094226 | (05) | MI |
D24119 | (02) |