Provider Demographics
NPI:1760583785
Name:CRONK, BRIAN (PA-C)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:CRONK
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 1:3702 S TIMBERLINE RD
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-3624
Mailing Address - Country:US
Mailing Address - Phone:970-207-9773
Mailing Address - Fax:970-207-1893
Practice Address - Street 1:3702 S TIMBERLINE RD
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3624
Practice Address - Country:US
Practice Address - Phone:970-207-9773
Practice Address - Fax:970-207-1893
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO643363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO002402359Medicaid
CO002402359Medicaid
COC33605Medicare PIN