Provider Demographics
NPI:1255406468
Name:SCLAR, RANDALL F (PA)
Entity type:Individual
Prefix:
First Name:RANDALL
Middle Name:F
Last Name:SCLAR
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28000 MEADOW DR #210
Mailing Address - Street 2:ARAPAHOE PEAK HEALTH CENTER
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439
Mailing Address - Country:US
Mailing Address - Phone:303-679-8500
Mailing Address - Fax:303-679-8505
Practice Address - Street 1:28000 MEADOW DR #210
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439
Practice Address - Country:US
Practice Address - Phone:303-679-8500
Practice Address - Fax:303-679-8505
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00731363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC544638OtherEMPLOYER PTAN
COC525318OtherPTAN
COP46578Medicare UPIN