Provider Demographics
NPI:1811090129
Name:MOOD, COREY D (PA-C)
Entity type:Individual
Prefix:
First Name:COREY
Middle Name:D
Last Name:MOOD
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 1:4900 S MONACO ST STE 210
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3487
Mailing Address - Country:US
Mailing Address - Phone:303-209-2503
Mailing Address - Fax:303-761-0803
Practice Address - Street 1:701 E HAMPDEN AVE STE 515
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-3880
Practice Address - Country:US
Practice Address - Phone:303-209-2503
Practice Address - Fax:303-761-0803
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL085-002802363A00000X
CO3075363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO40929701Medicaid
CO40929701Medicaid