Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 35894 | CO |
NPI | 1013915032 |
---|---|
Provider Name | Peter Wood |
First Address | Fort Collins, CO 80525-9718 |
Second Address | Longmont, CO 80503-6405 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2005 |
Last Update Date | 11/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E91102 | (02) |