Unknown Individual – Family Medicine Physician, NPI 1477558161
Family Medicine Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Unknown Individual
916, Indiana Avenue, Pueblo, Pueblo County, Colorado, 81004, United States
SUITE120
PUEBLO, CO 810043572
Phone: (719) 562-1122
Fax: (719) 562-0244
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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Educational use only—not medical, billing, or legal advice.
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 81004)
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