Provider Demographics
NPI:1619195393
Name:COLLOTON, MARK (PA)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:COLLOTON
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:9035 WADSWORTH PKWY
Mailing Address - Street 2:SUITE 3000
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80021-8634
Mailing Address - Country:US
Mailing Address - Phone:303-422-7677
Mailing Address - Fax:303-042-2602
Practice Address - Street 1:9035 WADSWORTH PKWY
Practice Address - Street 2:SUITE 3000
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80021-8634
Practice Address - Country:US
Practice Address - Phone:303-422-7677
Practice Address - Fax:303-042-2602
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO337363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO337OtherSTATE OF COLORADO LICENSE