=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891784831
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CRAIG ALAN LOERZEL D.O.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/20/2005
-----------------------------------------------------
Last Update Date | 05/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2960 N CIRCLE DR STE 100
-----------------------------------------------------
City | COLORADO SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80909-1163
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-741-6113
-----------------------------------------------------
Fax | 833-450-6109
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1080 ALLEGHENY DR
-----------------------------------------------------
City | COLORADO SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80919-1504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-232-5713
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | DR.0043249
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------