Healthcare Provider Details

I. General information

NPI: 1568500189
Provider Name (Legal Business Name): JOSEPH LEE HEGARTY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2007
Last Update Date: 05/15/2021
Certification Date: 05/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 PROFESSIONAL PL STE 100
COLORADO SPRINGS CO
80904-8106
US

IV. Provider business mailing address

2950 PROFESSIONAL PL STE 100
COLORADO SPRINGS CO
80904-8106
US

V. Phone/Fax

Practice location:
  • Phone: 719-667-1327
  • Fax: 719-667-1328
Mailing address:
  • Phone: 719-667-1327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number39522
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: