Healthcare Provider Details

I. General information

NPI: 1083609796
Provider Name (Legal Business Name): PUEBLO ASSOC IN OB & GYN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 MINNEQUA AVE
PUEBLO CO
81004-3734
US

IV. Provider business mailing address

1120 MINNEQUA AVE
PUEBLO CO
81004-3734
US

V. Phone/Fax

Practice location:
  • Phone: 719-564-0660
  • Fax: 719-564-0037
Mailing address:
  • Phone: 719-564-0660
  • Fax: 719-564-0037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateCO

VIII. Authorized Official

Name: DR. WILLIAM MACRAE CAMPBELL
Title or Position: PRESIDENT
Credential: DO
Phone: 719-564-0660