# PUEBLO EAR NOSE & THROAT SPECIALIST

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1306175484
- **Authorized official:** DR. CHARLENE HICKSON M.D. (OWNER)
- **Authorized official phone:** (719) 566-1277

## Contact information

- **Practice address:** 1218 PUEBLO BLVD WAY, PUEBLO, CO 81005-1507
- **Practice address phone:** (719) 566-1277
- **Practice address fax:** (719) 566-1257
- **Mailing address:** 1218 PUEBLO BLVD WAY, PUEBLO, CO 81005-1507
- **Mailing address phone:** (719) 566-1277
- **Mailing address fax:** (719) 566-1257

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Y00000X | Otolaryngology Physician | — | NULL | Yes |
| 207Y00000X | Otolaryngology Physician | — | — | Yes |

## Other

- **Enumeration date:** 12/18/2009
- **Last updated:** 04/16/2013