Organization
CORWIN CLINIC SURGICAL PROFESSIONAL CORP
Active
Other names
Corwin Clinic Surgical, PC
Organization subpart
No
Provider details
NPI number
Authorized official
GARY E. LANE MD (PRESIDENT)
(719) 564-0210
Entity
Organization
Contact information
Practice address
1925 E ORMAN AVE STE A109, PUEBLO, CO 81004-3555
(719) 564-0210
(719) 564-9483
Mailing address
1925 E ORMAN AVE STE A109, PUEBLO, CO 81004-3555
(719) 564-0210
(719) 564-9483
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04011417
—
CO
Enumeration date
01/16/2007
Last updated
03/23/2011
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