Provider Demographics
NPI:1265637037
Name:KURZ, NICHOLAS BRIAN (DO)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:BRIAN
Last Name:KURZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 B TALISMAN DRIVE #3
Mailing Address - Street 2:
Mailing Address - City:PAGOSA SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81147
Mailing Address - Country:US
Mailing Address - Phone:970-731-5252
Mailing Address - Fax:970-731-9922
Practice Address - Street 1:27 B TALISMAN DRIVE #3
Practice Address - Street 2:
Practice Address - City:PAGOSA SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81147
Practice Address - Country:US
Practice Address - Phone:970-731-5252
Practice Address - Fax:970-731-9922
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO43865207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05905851Medicaid
CO313624ZCQEMedicare PIN
CO313624Medicare UPIN
CO327007Medicare UPIN
CO05905851Medicaid
CO1265637037Medicare NSC
CO313624YWQJMedicare PIN