Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 48359 | CO |
NPI | 1215074596 |
---|---|
Provider Name | Trevor Lee Nydam |
First Address | Aurora, CO 80042-0429 |
Second Address | Aurora, CO 80045-2545 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2007 |
Last Update Date | 05/06/2013 |