Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0201X | Internist - Allergy & Immunology | 22482 | CO |
NPI | 1336293745 |
---|---|
Provider Name | Richard G. Luzietti |
First Address | Centennial, CO 80121-3433 |
Second Address | Aurora, CO 80012-5455 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2007 |
Last Update Date | 17/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01224823 | (05) | CO |
165997 | BLACK LUNG # (01) | CO |
22482 | STATE MEDICAL LICENSE # (01) | CO |
AL 9210903 | DEA # (01) | CO |
D24109 | (02) | CO |