Provider Demographics
NPI:1619273547
Name:CRAWFORD, COLBY LEE (PA-C)
Entity Type:Individual
Prefix:
First Name:COLBY
Middle Name:LEE
Last Name:CRAWFORD
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 1:2515 FORESIGHT CIR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505-1018
Mailing Address - Country:US
Mailing Address - Phone:970-245-2400
Mailing Address - Fax:970-242-9092
Practice Address - Street 1:2515 FORESIGHT CIR
Practice Address - Street 2:SUITE 200
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-1018
Practice Address - Country:US
Practice Address - Phone:970-245-2400
Practice Address - Fax:970-242-9092
Is Sole Proprietor?:No
Enumeration Date:2011-02-10
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA0003625363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO47875721Medicaid
CO47875721Medicaid