Provider Demographics
NPI:1700835857
Name:PAULSEN, MARK MCCLURE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:MCCLURE
Last Name:PAULSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:P.O. BOX 399
Mailing Address - Street 2:214 S. 4TH STREET
Mailing Address - City:KREMMLING
Mailing Address - State:CO
Mailing Address - Zip Code:80459-0399
Mailing Address - Country:US
Mailing Address - Phone:970-724-3442
Mailing Address - Fax:970-724-9606
Practice Address - Street 1:214 SOUTH 4TH STREET
Practice Address - Street 2:
Practice Address - City:KREMMLING
Practice Address - State:CO
Practice Address - Zip Code:80459-0399
Practice Address - Country:US
Practice Address - Phone:970-724-3442
Practice Address - Fax:970-724-9606
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO29741207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01297415Medicaid
E40408Medicare UPIN
CO01297415Medicaid
COE40408Medicare UPIN