Organization
UROLOGY OF SOUTHERN COLORADO PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANA JOAN WEAVER-OSTERHOLTZ M.D. (OWNER)
(719) 676-3728
Entity
Organization
Contact information
Practice address
3676 PARKER BLVD, SUITE 310, PUEBLO, CO 81008-2212
(719) 545-1500
Mailing address
3676 PARKER BLVD, SUITE 310, PUEBLO, CO 81008-2212
(719) 545-1500
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
40134
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
48477877
—
CO
Enumeration date
01/07/2008
Last updated
10/15/2009
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