Organization
LARS VAN ETTEN MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LARS VAN ETTEN MD (PRESIDENT)
(719) 242-5811
Entity
Organization
Contact information
Practice address
25 MONTEBELLO RD, PUEBLO, CO 81001-1236
(719) 544-1600
Mailing address
334 GRACE AVE, PUEBLO, CO 81004-1032
(719) 242-5811
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
261QP3300X
Pain Clinic/Center
—
—
Other
Enumeration date
11/15/2018
Last updated
11/15/2018
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