Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | 48651 | CO |
N | 208000000X | Pediatrician | MD00046618 | WA |
NPI | 1740370188 |
---|---|
Provider Name | Vongpheth Luangphaxay Mccarthy |
First Address | Denver, CO 80217-3862 |
Second Address | Aurora, CO 80012-5411 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2006 |
Last Update Date | 01/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8459422 | (05) | WA |
95002782 | (05) | CO |
N/A | (02) | |
P00835980 | RAILROAD PIN (01) | CO |