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Pueblo Family Medicine, PC

Clinic/Center, Primary Care in Pueblo, CO. Organization (NPI-2).

NPI number1114149986
StatusActive
Last updated in NPPESJan 22, 2010

Details

NPI
1114149986
Entity type
Organization (NPI-2)
Legal business name
Pueblo Family Medicine, PC
Organization subpart
No
Enumeration date
May 2, 2007
Last updated
Jan 22, 2010

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261QP2300X Clinic/Center, Primary Care–COYes

Practice location

1600 N Grand Ave Ste 310
Pueblo, CO 81003-2729

Phone 719-542-0072 · Fax 719-542-9888

Mailing address

1600 N Grand Ave Ste 310
Pueblo, CO 81003-2729

Phone 719-542-0072 · Fax 719-542-9888

Authorized official

Gregory W Berens
President
7195420072

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