Healthcare Provider Details

I. General information

NPI: 1508958612
Provider Name (Legal Business Name): MARSHAL ALAN UNREIN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 W 9TH AVE
FORT MORGAN CO
80701-2012
US

IV. Provider business mailing address

102 W 9TH AVE
FORT MORGAN CO
80701-2012
US

V. Phone/Fax

Practice location:
  • Phone: 970-867-5681
  • Fax: 970-867-7361
Mailing address:
  • Phone: 970-867-5681
  • Fax: 970-867-7361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA.0001385
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1385
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: