Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 29443 | CO |
NPI | 1073506929 |
---|---|
Provider Name | Mr. William Kelly Mccarty |
First Address | Colorado Springs, CO 80909-1658 |
Second Address | Colorado Springs, CO 80909-1658 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2005 |
Last Update Date | 09/12/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01294438 | (05) | CO |
A67372 | (02) |