Healthcare Provider Details

I. General information

NPI: 1639366149
Provider Name (Legal Business Name): GERALD HUANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: GERALD HUANG PA

II. Dates (important events)

Enumeration Date: 09/28/2007
Last Update Date: 02/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 W. MOUNTAIN VIEW AVE.
LONGMONT CO
80501-3129
US

IV. Provider business mailing address

PO BOX 1175
ENGLEWOOD CO
80150-1175
US

V. Phone/Fax

Practice location:
  • Phone: 303-306-7783
  • Fax: 303-306-7753
Mailing address:
  • Phone: 303-306-7783
  • Fax: 303-306-7753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2493
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: