Provider Demographics
NPI:1023134855
Name:FUGATE, TAE S (AAS)
Entity type:Individual
Prefix:MR
First Name:TAE
Middle Name:S
Last Name:FUGATE
Suffix:
Gender:M
Credentials:AAS
Other - Prefix:
Other - First Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1945
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80901-1945
Mailing Address - Country:US
Mailing Address - Phone:719-338-6715
Mailing Address - Fax:719-487-2689
Practice Address - Street 1:1745 CATNAP LN
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-6127
Practice Address - Country:US
Practice Address - Phone:719-888-1007
Practice Address - Fax:719-487-2689
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist