Healthcare Provider Details

I. General information

NPI: 1255453924
Provider Name (Legal Business Name): BERNARD-DEAN FRANK MARUCCI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 06/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 PUEBLO BOULEVARD WAY
PUEBLO CO
81005-2175
US

IV. Provider business mailing address

1207 PUEBLO BOULEVARD WAY
PUEBLO CO
81005-2175
US

V. Phone/Fax

Practice location:
  • Phone: 719-542-0032
  • Fax: 719-296-6217
Mailing address:
  • Phone: 719-542-0032
  • Fax: 719-296-6217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number14029
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: