Provider Demographics
NPI:1295394641
Name:FLEISCHMANN, TREVOR (PA-C)
Entity Type:Individual
Prefix:
First Name:TREVOR
Middle Name:
Last Name:FLEISCHMANN
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 1:1140 W SOUTH BOULDER RD STE 202
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-8910
Mailing Address - Country:US
Mailing Address - Phone:303-604-1444
Mailing Address - Fax:303-666-0911
Practice Address - Street 1:1140 W SOUTH BOULDER RD STE 202
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-8910
Practice Address - Country:US
Practice Address - Phone:303-604-1444
Practice Address - Fax:303-666-0911
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0007874363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical