Individual
MARIO J IMOLA
Active
Individual
MARIO J IMOLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207YS0123X
Facial Plastic Surgery Physician
Primary
38335
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
117142900
—
WY
01
—
841553144
TAX ID
CO
05
—
95739831
—
CO
Enumeration date
08/15/2005
Last updated
10/17/2011
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