Provider Demographics
NPI:1083746986
Name:ENGELKEN, GREGORY J (PA-C)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:J
Last Name:ENGELKEN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:950 E HARVARD AVE STE 550
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-7000
Mailing Address - Country:US
Mailing Address - Phone:303-778-6527
Mailing Address - Fax:303-733-1288
Practice Address - Street 1:950 E HARVARD AVE STE 550
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-7000
Practice Address - Country:US
Practice Address - Phone:303-778-6527
Practice Address - Fax:303-733-1288
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1150363AS0400X
COPA.0001150363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO18125727Medicaid
CO18125727Medicaid
COU29460Medicare UPIN