Individual
JUSTIN BUCHHOLZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
400 W 16TH ST, PUEBLO, CO 81003-2745
(719) 584-4000
Mailing address
4145 OUTLOOK BLVD UNIT H, PUEBLO, CO 81008-2609
(417) 459-0348
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
TL.0005704
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
TL.0005704
PHYSICIAN TRAINING LICENSE
CO
Enumeration date
06/11/2015
Last updated
06/11/2015
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