Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 29139 | OK |
Y | 207Q00000X | Family Doctor | 57341 | CO |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 57341 | CO |
NPI | 1528328317 |
---|---|
Provider Name | Stefani Madison |
First Address | Denver, CO 80204-4507 |
Second Address | Denver, CO 80204-4507 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2012 |
Last Update Date | 22/09/2016 |