Basic Information
| Provider Information | |||||||||
| NPI: | 1750458980 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZAMBONI-CUTTER | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | BENJAMIN | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 630 FERNGLEN CT | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809066803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7196508491 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1650 COCHRANE CIR | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809134603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195267653 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2006 | ||||||||
| LastUpdateDate: | 05/17/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 5101014755 | MI | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 47304 | CO | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.