Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 32864 | CO |
NPI | 1003873357 |
---|---|
Provider Name | Mr. Philip Adam Stull |
First Address | Aurora, CO 80012 |
Second Address | Aurora, CO 80012 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2006 |
Last Update Date | 15/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01328640 | (05) | CO |
F63056 | (02) |