Provider Demographics
NPI:1811917701
Name:MCVICKER, JOHN H (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:H
Last Name:MCVICKER
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Gender:M
Credentials:MD
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Mailing Address - Street 1:8890 N UNION BLVD
Mailing Address - Street 2:STE 160
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-7799
Mailing Address - Country:US
Mailing Address - Phone:719-365-9950
Mailing Address - Fax:719-365-9969
Practice Address - Street 1:1725 E BOULDER ST
Practice Address - Street 2:SUITE 101
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5768
Practice Address - Country:US
Practice Address - Phone:719-365-6300
Practice Address - Fax:719-365-6094
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2013-06-20
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Provider Licenses
StateLicense IDTaxonomies
CO28237207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01282375Medicaid
COD25063Medicare UPIN
COC806106Medicare PIN
CO01282375Medicaid