Provider Demographics
NPI:1558440537
Name:PARTRIDGE, CAROLE LYNN (MD)
Entity Type:Individual
Prefix:
First Name:CAROLE
Middle Name:LYNN
Last Name:PARTRIDGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:
Other - Last Name:PARTRIDGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2243 MAIN AVE
Mailing Address - Street 2:STE. 4E
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-4699
Mailing Address - Country:US
Mailing Address - Phone:970-749-8895
Mailing Address - Fax:970-385-4909
Practice Address - Street 1:2243 MAIN AVE
Practice Address - Street 2:STE. 4E
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-4699
Practice Address - Country:US
Practice Address - Phone:970-749-8895
Practice Address - Fax:970-385-4909
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO358282084P0800X
TXH46032084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCA4196Medicare PIN
COF02306Medicare UPIN