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General NPI Number Information
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NPI Number | 1023134855
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Entity Type | Individual
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Provider Name | TAE S FUGATE AAS
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Gender | Male
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 07/07/2022
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Provider Practice Location Address
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Address Line | 1745 CATNAP LN
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City | MONUMENT
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State | CO
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Zip | 80132-6127
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Country | US
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Telephone | 719-888-1007
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Fax | 719-487-2689
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Provider Business Mailing Address
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Address Line | PO BOX 1945
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City | COLORADO SPRINGS
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State | CO
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Zip | 80901-1945
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Country | US
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Telephone | 719-338-6715
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Fax | 719-487-2689
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZS0410X
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Taxonomy Name | Surgical Technologist
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License Number |
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License Number State |
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