Provider Demographics
NPI:1528195500
Name:MOSS, COLLEEN F (PA)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:F
Last Name:MOSS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2240 E BUCHTELL BLVD
Mailing Address - Street 2:#3 NORTH
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80208-0001
Mailing Address - Country:US
Mailing Address - Phone:303-871-6842
Mailing Address - Fax:303-871-4242
Practice Address - Street 1:2240 E BUCHTELL BLVD
Practice Address - Street 2:#3 NORTH
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80208-0001
Practice Address - Country:US
Practice Address - Phone:303-871-6842
Practice Address - Fax:303-871-4242
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO917363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO98101331Medicaid
009409OtherKAISER-COMMERCIAL NUMBER
009409OtherKAISER-COMMERCIAL NUMBER
COCK11007Medicare PIN
CO98101331Medicaid