Individual
KEVIN DOUGLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1012 W ABRIENDO AVE, PUEBLO, CO 81004-1128
(719) 545-2746
Mailing address
41 MONTEBELLO RD STE 204, PUEBLO, CO 81001-1379
(719) 545-2746
(719) 545-4100
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
11/04/2020
Last updated
11/04/2020
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