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NPI Code Detail

MEDICARE: DR. ALEXANDER T MCCULLOCH JR.

MEDICARE: DR. ALEXANDER T MCCULLOCH JR.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208200000XPlastic Surgery Physician24965CO

General Provider Information

NPI Number : 1114064029
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ALEXANDER T MCCULLOCH JR.
Provider Business Mailing Address
First Line : AESTHETIC SURGERY CENTER OF COLORADO
Second Line : 5901 CORPORATE DRIVE
City : COLORADO SPRINGS
State : CO
Zip : 80919
Country : US
Telephone Number : 719-597-1200
Fax Number : 719-597-2333
Provider Business Practice Location Address
First Line : 5901 CORPORATE DR
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80919-1941
Country : US
Telephone Number : 719-597-1200
Fax Number : 719-597-2333
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/31/2007
Last Update Date : 07/08/2007

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