Healthcare Provider Details

I. General information

NPI: 1043446636
Provider Name (Legal Business Name): DAVID S BEUTLER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2009
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E BOULDER ST STE 700
COLORADO SPRINGS CO
80909-5533
US

IV. Provider business mailing address

2695 ROCKY MOUNTAIN AVE STE 150
LOVELAND CO
80538-9071
US

V. Phone/Fax

Practice location:
  • Phone: 719-635-7172
  • Fax:
Mailing address:
  • Phone: 970-624-4451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License NumberDR.0055263
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: