Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | DR16544 | CO |
NPI | 1093813511 |
---|---|
Provider Name | Sanford Eldon Avner |
First Address | Lone Tree, CO 80124-5531 |
Second Address | Lone Tree, CO 80124-5531 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 15/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01165448 | (05) | CO |
D23089 | (02) | CO |