Healthcare Provider Details

I. General information

NPI: 1114237260
Provider Name (Legal Business Name): DAVID SONG CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2010
Last Update Date: 07/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12605 E 16TH AVE UNIVERSITY OF COLORADO HOSPITAL
AURORA CO
80045-2545
US

IV. Provider business mailing address

PO BOX 110429
AURORA CO
80042-0429
US

V. Phone/Fax

Practice location:
  • Phone: 720-848-0000
  • Fax: 720-848-0000
Mailing address:
  • Phone: 720-848-0000
  • Fax: 303-493-7000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2264745
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: