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NPI Profile for POUDRE VALLEY MEDICAL GROUP LLC in COLORADO SPRINGS, CO.
A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Vascular Surgery |
2086S0129X | 76 | Physician/Peripheral Vascular Disease | |
Phlebology |
202K00000X |
| NPI # | 1477168557 |
|
| Status | Active | |
| Credentials | ||
| Entity | Individual | |
| Enumeration date | 09/15/2020 | |
| Last updated | 07/30/2024 - More than a year ago | |
| Sole proprietor 1 | Not specified | |
| Identifiers | Not Available | |
| Hospital affiliation(s) | Not Available |
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POUDRE VALLEY MEDICAL GROUP, LLC