Provider Demographics
NPI:1639199920
Name:HOWLAND, GREGORY J SR
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:J
Last Name:HOWLAND
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:GREGORY
Other - Middle Name:J
Other - Last Name:HOWLAND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:2420 E PIKES PEAK AVE
Mailing Address - Street 2:SUITE 1044
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-6005
Mailing Address - Country:US
Mailing Address - Phone:719-365-6692
Mailing Address - Fax:719-365-5004
Practice Address - Street 1:8540 SCARBOROUGH DR
Practice Address - Street 2:SU. 100
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7502
Practice Address - Country:US
Practice Address - Phone:719-955-4200
Practice Address - Fax:719-955-4201
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0003665363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P53205Medicare UPIN