| NPI | 1790720464 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORI MOONEY-MALONE Practice Administrator 970-584-1063 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology |
| Additional Taxonomies | 207YX0905X Otolaryngology Otolaryngology/Facial Plastic Surgery |
| Enumeration Date | 2006-06-18 |
| Last Update Date | 2025-07-16 |