Healthcare Provider Details

I. General information

NPI: 1497504492
Provider Name (Legal Business Name): JOSEPH MATTHEW PADDOCK PA-S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2024
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 E HARMONY RD UNIT 100
FORT COLLINS CO
80528-3401
US

IV. Provider business mailing address

2121 E HARMONY RD UNIT 100
FORT COLLINS CO
80528-3401
US

V. Phone/Fax

Practice location:
  • Phone: 970-221-1000
  • Fax: 970-297-6886
Mailing address:
  • Phone: 970-624-2423
  • Fax: 970-490-4155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0009648
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: