Healthcare Provider Details

I. General information

NPI: 1104959022
Provider Name (Legal Business Name): TODD DUDLEY ST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 E PROSPECT ROAD ORTHOPAEDIC CENTER OF THE ROCKIES
FORT COLLINS CO
80525-9718
US

IV. Provider business mailing address

2500 E PROSPECT ROAD ORTHOPAEDIC CENTER OF THE ROCKIES
FORT COLLINS CO
80525-9718
US

V. Phone/Fax

Practice location:
  • Phone: 970-493-0112
  • Fax: 970-493-0521
Mailing address:
  • Phone: 970-493-0112
  • Fax: 970-493-0521

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: