Healthcare Provider Details

I. General information

NPI: 1952099749
Provider Name (Legal Business Name): COLORADO OTOLARYNGOLOGY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2023
Last Update Date: 04/28/2023
Certification Date: 04/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3595 E. SPAULDING AVENUE STE. B
PUEBLO CO
81008
US

IV. Provider business mailing address

PO BOX 9190
COLORADO SPRINGS CO
80932
US

V. Phone/Fax

Practice location:
  • Phone: 719-867-7800
  • Fax: 719-867-7899
Mailing address:
  • Phone: 719-867-7800
  • Fax: 719-867-7899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: NOAH LAZARUS
Title or Position: CEO
Credential:
Phone: 719-867-7800