Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 49582 | CO |
Y | 207QS0010X | Family Doctor - Sports Medicine | DR.0049582 | CO |
NPI | 1114155348 |
---|---|
Provider Name | Ralph Fletcher Colwell |
First Address | Grand Junction, CO 81507-2506 |
Second Address | Grand Junction, CO 11111-1111 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2009 |
Last Update Date | 20/12/2021 |