Provider Demographics
NPI:1841455417
Name:KUCERA, JOHN LAWRENCE (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:LAWRENCE
Last Name:KUCERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7606 N UNION BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-3850
Mailing Address - Country:US
Mailing Address - Phone:719-596-1118
Mailing Address - Fax:719-573-9774
Practice Address - Street 1:7606 N UNION BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3850
Practice Address - Country:US
Practice Address - Phone:719-596-1118
Practice Address - Fax:719-573-9774
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO26883207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine