Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | DR.0048512 | CO |
N | 207XS0106X | Orthopaedic Hand Surgeon | DR.0048512 | CO |
NPI | 1104091438 |
---|---|
Provider Name | Richard Michael Ackerson |
First Address | Fruita, CO 81521-0130 |
Second Address | Fruita, CO 81521-3308 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2008 |
Last Update Date | 23/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
369894YT1S | (02) |