Provider Demographics
NPI:1255490181
Name:DASTGEER, AHMAD WALID (PA SURGICAL)
Entity Type:Individual
Prefix:
First Name:AHMAD
Middle Name:WALID
Last Name:DASTGEER
Suffix:
Gender:M
Credentials:PA SURGICAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DASTGEER SURGICAL ASSOCIATES
Mailing Address - Street 2:P.O.BOX 41
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80038-0041
Mailing Address - Country:US
Mailing Address - Phone:720-300-1208
Mailing Address - Fax:303-410-6903
Practice Address - Street 1:4674 JASPER LN
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-8131
Practice Address - Country:US
Practice Address - Phone:720-300-1208
Practice Address - Fax:303-410-6903
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1280363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical