Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 31476 | CO |
Y | 208600000X | Surgeon | 31476 | CO |
NPI | 1013005024 |
---|---|
Provider Name | Walter B Vernon |
First Address | Englewood, CO 80110-2432 |
Second Address | Denver, CO 80220-3987 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 22/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01314764 | (05) | CO |
C86913 | (02) | CO |