Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | C0722 | CO |
NPI | 1922166362 |
---|---|
Provider Name | Robert O Greer |
First Address | Broomfield, CO 80038-0327 |
Second Address | Aurora, CO 80045-0000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2006 |
Last Update Date | 26/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
08678138 | (05) | CO |