Healthcare Provider Details

I. General information

NPI: 1669903365
Provider Name (Legal Business Name): COLE SEIFERS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2017
Last Update Date: 09/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 W 14TH ST PARKVIEW ADULT MEDICINE CLINIC ATTE COLE SEIFERS
PUEBLO CO
81003-2705
US

IV. Provider business mailing address

311 W 14TH ST PARKVIEW ADULT MEDICINE CLINIC ATTE COLE SEIFERS
PUEBLO CO
81003-2705
US

V. Phone/Fax

Practice location:
  • Phone: 719-595-7585
  • Fax: 719-595-7982
Mailing address:
  • Phone: 719-595-7585
  • Fax: 719-595-7982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTL0006415
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberTL.0006415
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: