Provider Demographics
NPI:1154863249
Name:HITCHCOCK, ZACHARY A (PA)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:A
Last Name:HITCHCOCK
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4674 SNOW MESA DR
Mailing Address - Street 2:SUITE 140
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-8615
Mailing Address - Country:US
Mailing Address - Phone:970-225-5000
Mailing Address - Fax:970-482-9646
Practice Address - Street 1:1107 S LEMAY AVE STE 240
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-3959
Practice Address - Country:US
Practice Address - Phone:970-495-7421
Practice Address - Fax:970-495-7424
Is Sole Proprietor?:No
Enumeration Date:2016-11-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA0004787363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO572060YLB8OtherMEDICARE
CO9000145629Medicaid