Provider Demographics
NPI:1891065017
Name:EDMONSON, ALAN CHAD (CST/CSFA)
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:CHAD
Last Name:EDMONSON
Suffix:
Gender:M
Credentials:CST/CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5073
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80155-5073
Mailing Address - Country:US
Mailing Address - Phone:303-953-1295
Mailing Address - Fax:
Practice Address - Street 1:9671 MILLSTONE CT
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80130-3371
Practice Address - Country:US
Practice Address - Phone:303-870-4937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-04
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSA.0001554246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant