Healthcare Provider Details

I. General information

NPI: 1396789772
Provider Name (Legal Business Name): BOBBY D. HOWARD D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 11/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

0310C COUNTY ROAD 14
DEL NORTE CO
81132-8719
US

IV. Provider business mailing address

0310 COUNTY ROAD 14
DEL NORTE CO
81132-8719
US

V. Phone/Fax

Practice location:
  • Phone: 719-657-2418
  • Fax: 719-657-3317
Mailing address:
  • Phone: 719-657-2510
  • Fax: 719-657-4106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number40752
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: