Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 21121 | CO |
Y | 207ND0900X | Dermatopathologist | 21121 | CO |
NPI | 1275544421 |
---|---|
Provider Name | Robert Chase Wright |
First Address | Denver, CO 80260-4713 |
Second Address | Denver, CO 80260-4713 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2006 |
Last Update Date | 07/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
21121 | MC LIC (01) | CO |
AW7751577 | DEA (01) | |
C03652 | (02) |