Healthcare Provider Details

I. General information

NPI: 1881682128
Provider Name (Legal Business Name): DAVID L HEADLEY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 04/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2312 N NEVADA AVE STE 400
COLORADO SPRINGS CO
80907-5320
US

IV. Provider business mailing address

7951 E MAPLEWOOD AVE SUITE 300
GREENWOOD VILLAGE CO
80111-4723
US

V. Phone/Fax

Practice location:
  • Phone: 719-577-2555
  • Fax: 719-577-2553
Mailing address:
  • Phone: 303-930-7800
  • Fax: 303-930-7860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number23965
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: