Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 345 | CO |
Y | 222Z00000X | Podiatrist | 345 | CO |
NPI | 1053381053 |
---|---|
Provider Name | Mr. Richard Charles |
First Address | Denver, CO 80238-2896 |
Second Address | Denver, CO 80206-4657 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2006 |
Last Update Date | 24/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01003458 | (05) | CO |
09107 | (02) |