Provider Demographics
NPI:1518279637
Name:VONDERHARR, MARK J (PA-C)
Entity Type:Individual
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First Name:MARK
Middle Name:J
Last Name:VONDERHARR
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Gender:M
Credentials:PA-C
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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
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Practice Address - Street 1:16222 W US HIGHWAY 24 STE 210
Practice Address - Street 2:
Practice Address - City:WOODLAND PARK
Practice Address - State:CO
Practice Address - Zip Code:80863-8763
Practice Address - Country:US
Practice Address - Phone:719-365-2960
Practice Address - Fax:719-374-6212
Is Sole Proprietor?:No
Enumeration Date:2010-07-06
Last Update Date:2023-01-06
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant