Provider Demographics
NPI:1568500189
Name:HEGARTY, JOSEPH LEE (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:LEE
Last Name:HEGARTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2950 PROFESSIONAL PL STE 100
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-8106
Mailing Address - Country:US
Mailing Address - Phone:719-667-1327
Mailing Address - Fax:
Practice Address - Street 1:2950 PROFESSIONAL PL STE 100
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-8106
Practice Address - Country:US
Practice Address - Phone:719-667-1327
Practice Address - Fax:719-667-1328
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2021-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO261QP2000X
CO39522207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO512198Medicare ID - Type Unspecified
COF67244Medicare UPIN