Provider Demographics
NPI:1609070382
Name:VINSON, MICHAEL OWEN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:OWEN
Last Name:VINSON
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 1:955 BONNIE BRAE BLVD
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-5101
Mailing Address - Country:US
Mailing Address - Phone:303-733-2959
Mailing Address - Fax:
Practice Address - Street 1:601 E HAMPDEN AVE STE 500
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2771
Practice Address - Country:US
Practice Address - Phone:303-788-6984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO714363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant