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General NPI Number Information
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NPI Number | 1194909515
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Entity Type | Organization
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Legal Business Name | NEUROLOGICAL SURGERY LTD PC
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Dates
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Enumeration Date | 12/20/2007
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Last Update Date | 12/20/2007
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Provider Practice Location Address
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Address Line | 2460 W 26TH AVE STE 220C
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City | DENVER
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State | CO
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Zip | 80211-5347
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Country | US
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Telephone | 303-455-1803
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Fax | 303-455-2644
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Provider Business Mailing Address
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Address Line | 2460 W 26TH AVE STE 220C
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City | DENVER
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State | CO
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Zip | 80211-5347
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Country | US
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Telephone | 303-455-1803
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | HERBERT IRA FRIED
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Credential | MD
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Telephone | 303-455-1803
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 23936
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License Number State | CO
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