| NPI | 1538459391 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEJA SIMMONS CEO 303-808-6282 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO 2076) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: FL PA 9104225) |
| Enumeration Date | 2011-04-13 |
| Last Update Date | 2013-09-19 |