Healthcare Provider Details

I. General information

NPI: 1558578336
Provider Name (Legal Business Name): FRANK R BORZAGER PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/27/2021
Certification Date: 07/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3850 GRANT AVE STE 200
LOVELAND CO
80538
US

IV. Provider business mailing address

3850 N GRANT AVE SUITE 200
LOVELAND CO
80538-8431
US

V. Phone/Fax

Practice location:
  • Phone: 970-624-5170
  • Fax: 970-669-7521
Mailing address:
  • Phone: 970-624-5170
  • Fax: 970-669-7521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA1145
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: