Healthcare Provider Details

I. General information

NPI: 1609129626
Provider Name (Legal Business Name): NICHOLAS L HUGENTOBLER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2012
Last Update Date: 05/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 RIVERGATE SUITE 105
DURANGO CO
81301
US

IV. Provider business mailing address

575 RIVERGATE SUITE 105
DURANGO CO
81301-7487
US

V. Phone/Fax

Practice location:
  • Phone: 970-259-3154
  • Fax: 970-828-1666
Mailing address:
  • Phone: 970-259-3154
  • Fax: 970-828-1666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPOD0000716
License Number StateCO

VIII. Authorized Official

Name: DR. NICHOLAS L HUGENTOBLER
Title or Position: PRESIDENT
Credential: DPM
Phone: 970-259-3154