Provider Demographics
NPI:1649322710
Name:CULBERT, CRYSTAL M (PA C)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:M
Last Name:CULBERT
Suffix:
Gender:F
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 1:7821 W 38TH AVE
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-6109
Mailing Address - Country:US
Mailing Address - Phone:303-422-2343
Mailing Address - Fax:303-422-8291
Practice Address - Street 1:7821 W 38TH AVE
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-6109
Practice Address - Country:US
Practice Address - Phone:303-422-2343
Practice Address - Fax:303-422-8291
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1323207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCF2908Medicare PIN