| Kyra Hootman DO PC | |
|
2001 Lake Ave Pueblo CO 81004-3538 | |
| (719) 564-0300 | |
| (719) 564-0303 |
| Full Name | Kyra Hootman DO PC |
|---|---|
| Speciality | Internal Medicine |
| Location | 2001 Lake Ave, Pueblo, Colorado |
| Authorized Official Name and Position | Carole J Walls (OFFICE MANAGER) |
| Authorized Official Contact | 7195640300 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kyra Hootman DO PC 2001 Lake Ave Pueblo CO 81004-3538 Ph: (719) 564-0300 | Kyra Hootman DO PC 2001 Lake Ave Pueblo CO 81004-3538 Ph: (719) 564-0300 |
| NPI Number | 1558528919 |
|---|---|
| Provider Enumeration Date | 05/21/2008 |
| Last Update Date | 10/29/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558528919 | NPI | - | NPPES |
| 89623827 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 38729 (Colorado) | Primary |
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