Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 18788 | CO |
NPI | 1063411726 |
---|---|
Provider Name | Patrick O Faricy |
First Address | Colorado Springs, CO 80906-4223 |
Second Address | Colorado Springs, CO 80910-3151 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2005 |
Last Update Date | 21/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01187889 | (05) | CO |
D23496 | (02) | CO |