Provider Demographics
NPI:1760568018
Name:PERNAK, GERALD (PA-C)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:
Last Name:PERNAK
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 1:2695 ROCKY MOUNTAIN AVE
Mailing Address - Street 2:STE 150
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9071
Mailing Address - Country:US
Mailing Address - Phone:970-624-2412
Mailing Address - Fax:
Practice Address - Street 1:9330 S UNIVERSITY BLVD STE 100&120
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80126
Practice Address - Country:US
Practice Address - Phone:303-346-3627
Practice Address - Fax:303-683-9392
Is Sole Proprietor?:No
Enumeration Date:2006-10-30
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA21868363A00000X
COPA.0005320363A00000X, 363AM0700X
ARPA-465363A00000X
MT570363A00000X
MI5601004896363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical