Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 25604 | CO |
NPI | 1093793119 |
---|---|
Provider Name | Susan D Carter |
First Address | Greeley, CO 80631-4500 |
Second Address | Greeley, CO 80631-4500 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2006 |
Last Update Date | 13/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01256049 | (05) | CO |
E30167 | (02) | CO |