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Organization
PUEBLO EAR NOSE & THROAT SPECIALIST
Active
Organization
PUEBLO EAR NOSE & THROAT SPECIALIST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLENE HICKSON M.D. (OWNER)
(719) 566-1277
Entity
Organization
Contact information
Practice address
1218 PUEBLO BLVD WAY, PUEBLO, CO 81005-1507
(719) 566-1277
(719) 566-1257
Mailing address
1218 PUEBLO BLVD WAY, PUEBLO, CO 81005-1507
(719) 566-1277
(719) 566-1257
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
—
NULL
207Y00000X
Otolaryngology Physician
Primary
—
—
Other
Enumeration date
12/18/2009
Last updated
04/16/2013
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