Healthcare Provider Details

I. General information

NPI: 1902823578
Provider Name (Legal Business Name): PAUL EUGENE RECKARD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 10/11/2022
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E BOULDER ST STE 600
COLORADO SPRINGS CO
80909-5533
US

IV. Provider business mailing address

8890 N UNION BLVD STE 160
COLORADO SPRINGS CO
80920-7799
US

V. Phone/Fax

Practice location:
  • Phone: 719-364-6487
  • Fax: 719-364-6488
Mailing address:
  • Phone: 719-365-9950
  • Fax: 719-365-9969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number33021
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number33021-20
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number33021-20
License Number StateWI
# 4
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberDR-51777
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: