Individual
PHILIP CHARLES MARIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1304 N GRAND AVE, PUEBLO, CO 81003-2718
(719) 669-8487
(719) 669-8488
Mailing address
1304 N GRAND AVE, PUEBLO, CO 81003-2718
(719) 669-8487
(719) 669-8488
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
40500
CO
2082S0105X
Surgery of the Hand (Plastic Surgery) Physician
40500
CO
2086S0122X
Plastic and Reconstructive Surgery Physician
0040500
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00073
HMO CO
—
01
—
00320
INSURANCE
—
01
—
61101
HUMANA GOLD
—
01
—
71412
UNITED OF OMAHA
—
01
—
MA65799
BLUE CROSS BLUE SHIELD
CO
01
—
P00213540
MEDICARE RAILROAD
—
01
—
TDDIR
TRICARE
—
Enumeration date
07/07/2006
Last updated
04/05/2023
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