Provider Demographics
NPI:1275604514
Name:ELDER, BRIAN KEVIN (PA-C)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:KEVIN
Last Name:ELDER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9071
Mailing Address - Country:US
Mailing Address - Phone:970-624-4323
Mailing Address - Fax:
Practice Address - Street 1:4674 SNOW MESA DR STE 200
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-8614
Practice Address - Country:US
Practice Address - Phone:970-266-3650
Practice Address - Fax:970-266-3660
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYTL404363AM0700X
363AM0700X
COPA.0003611363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COPA.0002611OtherPHYSICIAN ASSISTANT