Provider Demographics
NPI:1508378423
Name:MCDUFFEE, NICOLAS A (PA-C)
Entity Type:Individual
Prefix:
First Name:NICOLAS
Middle Name:A
Last Name:MCDUFFEE
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 1:520 EMERSON ST
Mailing Address - Street 2:
Mailing Address - City:WRAY
Mailing Address - State:CO
Mailing Address - Zip Code:80758-1521
Mailing Address - Country:US
Mailing Address - Phone:303-478-9036
Mailing Address - Fax:
Practice Address - Street 1:1017 W 7TH ST
Practice Address - Street 2:
Practice Address - City:WRAY
Practice Address - State:CO
Practice Address - Zip Code:80758-1420
Practice Address - Country:US
Practice Address - Phone:970-332-4895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-01
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0005183363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant