Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 47459 | CO |
Y | 208600000X | Surgeon | 47459 | CO |
N | 2086S0127X | Trauma Surgeon | 34611 | TN |
NPI | 1023085511 |
---|---|
Provider Name | Robert Peteris Vickerman |
First Address | Greeley, CO 80631-4500 |
Second Address | Greeley, CO 80631-4500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2006 |
Last Update Date | 29/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3858329 | (05) | TN |
H22690 | (02) | TN |