MEDICARE: COLTON WRIGHT

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	390200000X	Student in an Organized Health Care Education/Training Program
2	363A00000X	Physician Assistant	0008584	CO

General Provider Information

NPI Number	:	1679335319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLTON WRIGHT

Provider Business Mailing Address
First Line	:	2284 S ORCHARD ST
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80228-6471
Country	:	US
Telephone Number	:	815-713-7779
Fax Number	:

Provider Business Practice Location Address
First Line	:	2284 S ORCHARD ST
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80228-6471
Country	:	US
Telephone Number	:	815-713-7779
Fax Number	:

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

Provider Enumeration Date	:	01/29/2024
Last Update Date	:	05/20/2024

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Directions to “ COLTON WRIGHT ” Practice Location

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