Provider Demographics
NPI:1437156742
Name:PATTRIDGE, MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:PATTRIDGE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1707 COLE BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-3220
Mailing Address - Country:US
Mailing Address - Phone:303-716-8013
Mailing Address - Fax:303-763-5495
Practice Address - Street 1:1030 JOHNSON RD
Practice Address - Street 2:STE 200
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-6003
Practice Address - Country:US
Practice Address - Phone:303-278-4600
Practice Address - Fax:303-278-7263
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2013-10-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO26928207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01269281Medicaid
CO01269281Medicaid
CON1174Medicare ID - Type Unspecified