Healthcare Provider Details

I. General information

NPI: 1104817519
Provider Name (Legal Business Name): ERIC M WASHYCHYN PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 10/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8101 E LOWRY BLVD SUITE 260
DENVER CO
80230-7196
US

IV. Provider business mailing address

8101 E LOWRY BLVD SUITE 260
DENVER CO
80230-7196
US

V. Phone/Fax

Practice location:
  • Phone: 303-214-4500
  • Fax: 303-214-4571
Mailing address:
  • Phone: 303-214-4500
  • Fax: 303-214-4571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number1335
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: