Healthcare Provider Details

I. General information

NPI: 1437156742
Provider Name (Legal Business Name): MARK PATTRIDGE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 10/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 JOHNSON RD STE 200
GOLDEN CO
80401-6003
US

IV. Provider business mailing address

1707 COLE BLVD STE 100
GOLDEN CO
80401-3220
US

V. Phone/Fax

Practice location:
  • Phone: 303-278-4600
  • Fax: 303-278-7263
Mailing address:
  • Phone: 303-716-8013
  • Fax: 303-763-5495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number26928
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: