Healthcare Provider Details

I. General information

NPI: 1629085105
Provider Name (Legal Business Name): DOUGLAS REX HESS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 03/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S SANTA FE AVE SUITE 500
PUEBLO CO
81003-4270
US

IV. Provider business mailing address

PO BOX 570
PUEBLO CO
81002-0570
US

V. Phone/Fax

Practice location:
  • Phone: 719-296-5840
  • Fax: 719-542-0746
Mailing address:
  • Phone: 719-296-5840
  • Fax: 719-542-0746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number27403
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number27403
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: