Provider Demographics
NPI:1013458116
Name:TRUSHEL, GREGORY
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:TRUSHEL
Suffix:
Gender:M
Credentials:
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 213
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:CO
Mailing Address - Zip Code:80640-0213
Mailing Address - Country:US
Mailing Address - Phone:720-333-1454
Mailing Address - Fax:
Practice Address - Street 1:9615 E 113TH AVE
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:CO
Practice Address - Zip Code:80640-9364
Practice Address - Country:US
Practice Address - Phone:720-333-1454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-09
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSA.0002230246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Multi-Specialty