Healthcare Provider Details

I. General information

NPI: 1306826482
Provider Name (Legal Business Name): PIKES PEAK RADIATION ONCOLOGY P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 N UNION BLVD SUITE 202
COLORADO SPRINGS CO
80909-2871
US

IV. Provider business mailing address

1425 N UNION BLVD SUITE 202
COLORADO SPRINGS CO
80909-2871
US

V. Phone/Fax

Practice location:
  • Phone: 719-570-7675
  • Fax: 719-471-9314
Mailing address:
  • Phone: 719-570-7675
  • Fax: 719-471-9314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number StateCO

VIII. Authorized Official

Name: DR. MARK B HAZUKA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 719-570-7675