Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 38275 | CO |
Y | 213ES0000X | Sports Medicine | 38275 | CO |
NPI | 1053317982 |
---|---|
Provider Name | Scott Raub |
First Address | Grand Junction, CO 81502-3199 |
Second Address | Frisco, CO 80443 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2005 |
Last Update Date | 11/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G86531 | (02) | CO |