Doctor Name: | COLIN STRACK |
NPI Number: | 1003274192 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PA-C |
License Number: | 0004513 |
Business Practice Address: | 205 S Main St Suite A Longmont, CO - 805011716 |
Business Phone Number: | 3037766115 |
Business Fax Number: | 3037764318 |
Mailing Address: | 4801 S Wadsworth Blvd, Apt 11-202 LITTLETON |
State: | CO |
Postal Code: | 80123 |
Phone Number: | 9705561137 |
Fax Number: | |
NPI Enumeration Date: | 02/03/2016 |
NPI Last Update Date: | 02/03/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 0004513 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CO |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |