Healthcare Provider Details

I. General information

NPI: 1447245139
Provider Name (Legal Business Name): BRETT L HULET MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 04/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 COLORADO AVE
PUEBLO CO
81004
US

IV. Provider business mailing address

110 E ROUTT AVE
PUEBLO CO
81004
US

V. Phone/Fax

Practice location:
  • Phone: 719-543-8711
  • Fax: 719-543-5340
Mailing address:
  • Phone: 719-543-8711
  • Fax: 719-543-5340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number26659
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: