Provider Demographics
NPI:1962498717
Name:COLORADO SPRINGS PLASTIC SURGERY
Entity Type:Organization
Organization Name:COLORADO SPRINGS PLASTIC SURGERY
Other - Org Name:DAVID D DUBOIS MD
Other - Org Type:Other Name
Authorized Official - Title/Position:BILLING REPRESENTATIVE
Authorized Official - Prefix:MRS
Authorized Official - First Name:GEORGETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-632-1818
Mailing Address - Street 1:2727 N TEJON ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-6231
Mailing Address - Country:US
Mailing Address - Phone:719-632-1818
Mailing Address - Fax:719-632-4615
Practice Address - Street 1:2727 N TEJON ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-6231
Practice Address - Country:US
Practice Address - Phone:719-632-1818
Practice Address - Fax:719-632-4615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO18974208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01189745Medicaid
CO70ZZ4Medicare ID - Type Unspecified
D23529Medicare UPIN