Provider Demographics
NPI:1083869754
Name:TODD, GINGER RAE (PA-C)
Entity Type:Individual
Prefix:
First Name:GINGER
Middle Name:RAE
Last Name:TODD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:GINGER
Other - Middle Name:R
Other - Last Name:WATTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1726 COLE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80401-3213
Mailing Address - Country:US
Mailing Address - Phone:303-403-7381
Mailing Address - Fax:303-403-6254
Practice Address - Street 1:1726 COLE BLVD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80401-3213
Practice Address - Country:US
Practice Address - Phone:303-403-7381
Practice Address - Fax:303-403-6254
Is Sole Proprietor?:No
Enumeration Date:2008-11-22
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2726363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO51178877Medicaid