Provider Demographics
NPI:1225326978
Name:LEMBACH, MARK S (PAC)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:S
Last Name:LEMBACH
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
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Mailing Address - Street 1:5450 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2709
Mailing Address - Country:US
Mailing Address - Phone:303-442-2395
Mailing Address - Fax:303-442-1073
Practice Address - Street 1:4743 ARAPAHOE AVE STE 201
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1128
Practice Address - Country:US
Practice Address - Phone:303-442-2395
Practice Address - Fax:303-442-1073
Is Sole Proprietor?:No
Enumeration Date:2011-07-15
Last Update Date:2018-10-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI2794363A00000X
COPA.0005518363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant