# PUEBLO ORTHOPEDIC PROFESSIONAL CORPORATION

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

## Provider details

- **NPI number:** 1497780498
- **Authorized official:** JAN G DAVIS M.D. (OWNER)
- **Authorized official phone:** (719) 564-0390

## Contact information

- **Practice address:** 1008 MINNEQUA AVE \# 1501, PUEBLO, CO 81004-3733
- **Practice address phone:** (719) 564-0390
- **Practice address fax:** (719) 560-9359
- **Mailing address:** 1008 MINNEQUA AVE \# 1501, PUEBLO, CO 81004-3733
- **Mailing address phone:** (719) 564-0390
- **Mailing address fax:** (719) 560-9359

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/11/2006
- **Last updated:** 07/20/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 04005898 | — | CO |
| 01 | — | 200221998 | RAILROAD MEDICARE | CO |