Healthcare Provider Details

I. General information

NPI: 1255859526
Provider Name (Legal Business Name): JAMES BRADLEY HSUEH M.M.S, PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2017
Last Update Date: 04/07/2020
Certification Date: 04/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2767 JANITELL RD
COLORADO SPRINGS CO
80906-4102
US

IV. Provider business mailing address

2349 N 12TH ST
PHOENIX AZ
85006-2377
US

V. Phone/Fax

Practice location:
  • Phone: 719-365-2888
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0005836
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: