1508096116 NPI number — NICHOLAS LELAND HUGENTOBLER DPM

Table of content: NICHOLAS LELAND HUGENTOBLER DPM (NPI 1508096116)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508096116 NPI number — NICHOLAS LELAND HUGENTOBLER DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUGENTOBLER
Provider First Name:
NICHOLAS
Provider Middle Name:
LELAND
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508096116
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6405 S 3000 E STE 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALT LAKE CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84121-6990
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-266-3113
Provider Business Mailing Address Fax Number:
801-266-5633

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
270 E 8TH AVE
Provider Second Line Business Practice Location Address:
SUITE N102
Provider Business Practice Location Address City Name:
DURANGO
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81301-5708
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-903-9853
Provider Business Practice Location Address Fax Number:
970-616-6745
Provider Enumeration Date:
07/16/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  POD.344 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0103X , with the licence number: 716 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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