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Organization
PUEBLO ORTHOPEDIC PROFESSIONAL CORPORATION
Active
Organization
PUEBLO ORTHOPEDIC PROFESSIONAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAN G DAVIS M.D. (OWNER)
(719) 564-0390
Entity
Organization
Contact information
Practice address
1008 MINNEQUA AVE # 1501, PUEBLO, CO 81004-3733
(719) 564-0390
(719) 560-9359
Mailing address
1008 MINNEQUA AVE # 1501, PUEBLO, CO 81004-3733
(719) 564-0390
(719) 560-9359
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
NULL
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04005898
—
CO
01
—
200221998
RAILROAD MEDICARE
CO
Enumeration date
07/11/2006
Last updated
07/20/2009
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