Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0101X | MOHS-Micrographic Surgeon | 264547 | CO |
NPI | 1306258777 |
---|---|
Provider Name | Wayne Joseph Overman II |
First Address | Denver, CO 80202-1602 |
Second Address | Arvada, CO 80005-1338 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2014 |
Last Update Date | 15/12/2020 |