Provider Demographics
NPI:1437108131
Name:HOOTMAN, KYRA K (DO)
Entity Type:Individual
Prefix:
First Name:KYRA
Middle Name:K
Last Name:HOOTMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-3535
Mailing Address - Country:US
Mailing Address - Phone:719-564-0300
Mailing Address - Fax:719-564-0303
Practice Address - Street 1:2001 LAKE AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-3535
Practice Address - Country:US
Practice Address - Phone:719-564-0300
Practice Address - Fax:719-564-0303
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO38729207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO62781847Medicaid
COC437908Medicare PIN
COCO300743Medicare UPIN
CO62781847Medicaid