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NPI Code Detail

MEDICARE: DR. ROBERT LOUIS MANGUSO M.D.

MEDICARE: DR. ROBERT LOUIS MANGUSO M.D.
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
1207R00000XInternal Medicine Physician20792CO

General Provider Information

NPI Number : 1568405892
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROBERT LOUIS MANGUSO M.D.
Provider Business Mailing Address
First Line : 1600 W 24TH ST
Second Line :
City : PUEBLO
State : CO
Zip : 81003-1411
Country : US
Telephone Number : 719-546-4313
Fax Number : 719-546-4425
Provider Business Practice Location Address
First Line : 1600 W 24TH ST
Second Line :
City : PUEBLO
State : CO
Zip : 81003-1411
Country : US
Telephone Number : 719-546-4313
Fax Number : 719-546-4425
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2006
Last Update Date : 07/08/2007

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