Provider Demographics
NPI:1780651703
Name:HATERIUS, RICK D (MD)
Entity Type:Individual
Prefix:
First Name:RICK
Middle Name:D
Last Name:HATERIUS
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:PO BOX 820
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80901-0820
Mailing Address - Country:US
Mailing Address - Phone:719-448-0981
Mailing Address - Fax:719-448-0767
Practice Address - Street 1:2222 N NEVADA AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-6819
Practice Address - Country:US
Practice Address - Phone:719-776-5000
Practice Address - Fax:719-448-0767
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO30851207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO050047266OtherRAILROAD MEDICARE NUMBER
CO01308519Medicaid
COE32375Medicare UPIN
CO01308519Medicaid