Healthcare Provider Details

I. General information

NPI: 1346466109
Provider Name (Legal Business Name): MITCHELL DAVID MUSSER SURGICAL ASSISTANT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 04/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 FRANKLIN ST BLD 2 SUITE 410
DENVER CO
80205-5401
US

IV. Provider business mailing address

2184 RANCHERO DRIVE
MONUMENT CO
80132-7126
US

V. Phone/Fax

Practice location:
  • Phone: 303-839-1616
  • Fax: 303-839-1991
Mailing address:
  • Phone: 719-338-1244
  • Fax: 303-839-1616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: