Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 21280 | WV |
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 252522 | NY |
NPI | 1528163979 |
---|---|
Provider Name | Paul G Van Der Sloot |
First Address | Denver, CO 80237-3487 |
Second Address | Englewood, CO 80113-2737 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2006 |
Last Update Date | 10/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03117264 | (05) | NY |
1809555000 | (05) | WV |