Provider Demographics
NPI:1619165628
Name:STROMER, BRIAN P (PA-C)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:P
Last Name:STROMER
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 1:2930 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:CO
Mailing Address - Zip Code:80620-1011
Mailing Address - Country:US
Mailing Address - Phone:970-353-1130
Mailing Address - Fax:970-353-9906
Practice Address - Street 1:100 N 11TH AVE
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-2011
Practice Address - Country:US
Practice Address - Phone:970-352-8898
Practice Address - Fax:970-351-7075
Is Sole Proprietor?:No
Enumeration Date:2007-10-04
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2502363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO16287088Medicaid