Unknown Individual – Surgical Physician Assistant, NPI 1154529790
Surgical Physician Assistant
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Unknown Individual
1600, West 24th Street, Northside, Pueblo, Pueblo County, Colorado, 81003, United States
PUEBLO, CO 810031411
Phone: (719) 546-4102
Mailing address matches the actual address.
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
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Medicare Enrollment & Revalidation
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No Medicare enrollment or revalidation data available for this provider in our database.
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Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
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No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 81003)
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