Pueblo Orthopedic Professional Corporation

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

Legal business name

PUEBLO ORTHOPEDIC PROFESSIONAL CORPORATION

Practice address

1008 Minnequa Ave # 1501
Pueblo, CO 81004-3733

Phone

(719) 564-0390

Fax

(719) 560-9359

NPI assigned

Jul 11, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jan G Davis, M.D.NPI 1316975501

Title

Owner

Phone

(719) 564-0390

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jan G Davis, M.D.

  • Orthopaedic Surgery Physician
  • Pueblo, CO
  • NPI 1316975501
  NPD (past) Authorized official
• Molly S. Kliewer, FNP-BC, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Pueblo, CO
  • NPI 1598833691
  NPD (past)
• Shawn Jett Nakamura, M.D.

  • Orthopaedic Surgery Physician
  • Pueblo, CO
  • NPI 1063497246
  NPD (past)
• Gregg Travis Graham, FNP

  • Family Nurse Practitioner
  • Concord, NC
  • NPI 1356401574
  NPD (past)
• Thomas F Stark, MD

  • Orthopaedic Surgery Physician
  • Everett, WA
  • NPI 1760422315
  NPD (past)
• Bruce Kenneth Taylor, M.D.

  • Orthopaedic Surgery Physician
  • Red Bluff, CA
  • NPI 1962430835
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1248048000000",
    "number": "1497780498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1008 MINNEQUA AVE # 1501",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810043733",
            "telephone_number": "719-564-0390",
            "fax_number": "719-560-9359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1008 MINNEQUA AVE # 1501",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810043733",
            "telephone_number": "719-564-0390",
            "fax_number": "719-560-9359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUEBLO ORTHOPEDIC PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-11",
        "last_updated": "2009-07-20",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "JAN",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "719-564-0390",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04005898",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "200221998",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pueblo Pathology Group, PC
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• Pueblo Pioneer Psychology LLC
• Pueblo Pulmonary Associates

• Orthopaedic Surgery Physician in Pueblo, CO
• Providers in Pueblo, CO by specialty
• Orthopaedic Surgery Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.