Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0201X | Internist - Allergy & Immunology | 21249 | CO |
N | 207RA0201X | Internist - Allergy & Immunology | 25825 | FL |
NPI | 1487648077 |
---|---|
Provider Name | Mr. Robert Alan Nathan |
First Address | Colorado Springs, CO 80907-6231 |
Second Address | Colorado Springs, CO 80907-6231 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2005 |
Last Update Date | 30/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01212497 | (05) | CO |
AN7815511 | DEA (01) | |
D23911 | (02) |