Provider Demographics
NPI:1447598552
Name:CITKOVIC, ROBERT S (PA)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:S
Last Name:CITKOVIC
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2021 NORTH 12TH STREET
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501
Mailing Address - Country:US
Mailing Address - Phone:970-242-0920
Mailing Address - Fax:970-256-6515
Practice Address - Street 1:2021 NORTH 12TH STREET
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501
Practice Address - Country:US
Practice Address - Phone:970-242-0920
Practice Address - Fax:970-256-6515
Is Sole Proprietor?:No
Enumeration Date:2013-01-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant