Healthcare Provider Details

I. General information

NPI: 1871606954
Provider Name (Legal Business Name): OAKWOOD UROLOGY CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1647 E 18TH ST
LOVELAND CO
80538-4209
US

IV. Provider business mailing address

1647 E 18TH ST
LOVELAND CO
80538-4209
US

V. Phone/Fax

Practice location:
  • Phone: 970-669-9100
  • Fax:
Mailing address:
  • Phone: 970-669-9100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number23635
License Number StateCO

VIII. Authorized Official

Name: JAN B HUDSON
Title or Position: OFFICE MANAGER
Credential:
Phone: 970-669-9100