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NPI Code Detail

MEDICARE: MRS. ANDREA PATT MOON P.A.

MEDICARE: MRS. ANDREA PATT MOON P.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant2104CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1710054143
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ANDREA PATT MOON P.A.
Provider Business Mailing Address
First Line : 1805 SHEA CENTER DR STE 450
Second Line :
City : HIGHLANDS RANCH
State : CO
Zip : 80129-2255
Country : US
Telephone Number : 303-357-2559
Fax Number : 303-814-0505
Provider Business Practice Location Address
First Line : 7280 LAGAE RD STE J
Second Line :
City : CASTLE PINES
State : CO
Zip : 80108-9454
Country : US
Telephone Number : 303-814-0505
Fax Number : 303-814-6491
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/29/2006
Last Update Date : 09/30/2024

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