Healthcare Provider Details

I. General information

NPI: 1285634121
Provider Name (Legal Business Name): ROBERT D MCCURRY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 03/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 MAIN ST
CANON CITY CO
81212-3506
US

IV. Provider business mailing address

1210 MAIN ST
CANON CITY CO
81212-3506
US

V. Phone/Fax

Practice location:
  • Phone: 719-275-3000
  • Fax: 719-275-6939
Mailing address:
  • Phone: 719-275-3000
  • Fax: 719-275-6939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number32118
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: