Healthcare Provider Details

I. General information

NPI: 1912996190
Provider Name (Legal Business Name): STEVEN B WASKOW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 10/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1633 MEDICAL CENTER POINT
COLORADO SPRINGS CO
80907-1604
US

IV. Provider business mailing address

1633 MEDICAL CENTER POINT
COLORADO SPRINGS CO
80907-1604
US

V. Phone/Fax

Practice location:
  • Phone: 719-447-1000
  • Fax: 719-447-8841
Mailing address:
  • Phone: 719-447-1000
  • Fax: 719-447-8841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number32905
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: