MEDICARE: MARK PACKER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	MD22302	OR
2	207W00000X	Ophthalmology Physician	75599	CA
3	207W00000X	Ophthalmology Physician	DR.0054602	CO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	180043385	OTHER		RAILROAD MEDICARE
3	180040741	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205834439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK PACKER M.D.

Provider Business Mailing Address
First Line	:	1400 BLUEBELL AVE
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80302-7834
Country	:	US
Telephone Number	:	541-915-0291
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 BLUEBELL AVE
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80302-7834
Country	:	US
Telephone Number	:	541-915-0291
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	12/20/2018

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Directions to “ MARK PACKER M.D.” Practice Location

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