Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 28931 | CO |
NPI | 1033123401 |
---|---|
Provider Name | Raeburn M. Jenkins |
First Address | Golden, CO 80401-9541 |
Second Address | Golden, CO 80401-9541 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 10/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01289313 | (05) | CO |
E70749 | (02) | CO |