Provider Demographics
NPI:1982600037
Name:AMMONS, MARK A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:AMMONS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1960 OGDEN ST
Mailing Address - Street 2:SUITE 540
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-3666
Mailing Address - Country:US
Mailing Address - Phone:303-318-2440
Mailing Address - Fax:303-318-2485
Practice Address - Street 1:1960 OGDEN ST
Practice Address - Street 2:SUITE 540
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-3666
Practice Address - Country:US
Practice Address - Phone:303-318-2440
Practice Address - Fax:303-318-2485
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO27675208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01276757Medicaid
CO01276757Medicaid
COD24985Medicare UPIN
CO91038Medicare ID - Type Unspecified