Provider Demographics
NPI:1912371865
Name:BINGHAM, WILLIAM GREG (PA-C)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:GREG
Last Name:BINGHAM
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 17982
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4074
Mailing Address - Country:US
Mailing Address - Phone:303-796-4802
Mailing Address - Fax:303-996-0695
Practice Address - Street 1:9785 MAROON CIR STE G104
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-5922
Practice Address - Country:US
Practice Address - Phone:303-779-1172
Practice Address - Fax:303-779-8553
Is Sole Proprietor?:No
Enumeration Date:2015-11-16
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0004410363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO49730142Medicaid