Provider Demographics
NPI:1679008940
Name:AMDURER, ZACH
Entity Type:Individual
Prefix:
First Name:ZACH
Middle Name:
Last Name:AMDURER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8550 W 38TH AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-4342
Mailing Address - Country:US
Mailing Address - Phone:303-403-3670
Mailing Address - Fax:
Practice Address - Street 1:8550 W 38TH AVE STE 220
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-4342
Practice Address - Country:US
Practice Address - Phone:303-403-3670
Practice Address - Fax:303-403-6489
Is Sole Proprietor?:No
Enumeration Date:2017-04-25
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0005019363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant