Healthcare Provider Details

I. General information

NPI: 1760404693
Provider Name (Legal Business Name): NATHAN E BEDOSKY P.A.-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 04/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 W 20TH ST UNIT 101 ATTN: SUE,CREDENTIALING
GREELEY CO
80634-9640
US

IV. Provider business mailing address

6801 W 20TH ST UNIT 101 ATTN: SUE,CREDENTIALING
GREELEY CO
80634-9640
US

V. Phone/Fax

Practice location:
  • Phone: 970-378-8000
  • Fax: 970-378-8088
Mailing address:
  • Phone: 970-378-8000
  • Fax: 970-378-8088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number3279
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA0003466
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: