Healthcare Provider Details

I. General information

NPI: 1992788194
Provider Name (Legal Business Name): CHRISTOPHER A BUREAU PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 02/11/2021
Certification Date: 02/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 ROCKY MOUNTAIN AVE NMOB SUITE 2200
LOVELAND CO
80538-8053
US

IV. Provider business mailing address

2500 ROCKY MOUNTAIN AVE NMOB SUITE 2200
LOVELAND CO
80538-9004
US

V. Phone/Fax

Practice location:
  • Phone: 970-203-7250
  • Fax:
Mailing address:
  • Phone: 970-203-7250
  • Fax: 970-619-6094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0002056
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA.0002056
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: