Individual
MR. HISMAN H PERCIVAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1600 N GRAND AVE, SUITE 430, PUEBLO, CO 81003-2700
(719) 545-8240
(719) 545-4319
Mailing address
1600 N GRAND AVE, SUITE 430, PUEBLO, CO 81003-2700
(719) 545-8240
(719) 545-4319
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
48086
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
87458748
—
CO
01
—
CO306605
MEDICARE PTAN
CO
Enumeration date
05/31/2005
Last updated
07/19/2012
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