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General NPI Number Information
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NPI Number | 1003274192
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Entity Type | Individual
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Provider Name | COLIN STRACK PA-C
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Gender | Male
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Dates
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Enumeration Date | 02/03/2016
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Last Update Date | 09/22/2021
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Provider Practice Location Address
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Address Line | 2555 E 13TH ST STE 220
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City | LOVELAND
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State | CO
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Zip | 80537-5136
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Country | US
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Telephone | 970-669-5432
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Fax | 970-207-1893
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Provider Business Mailing Address
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Address Line | 3702 S TIMBERLINE RD STE A
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City | FORT COLLINS
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State | CO
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Zip | 80525-3625
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 0004513
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License Number State | CO
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