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1760568018

NPI Code Detail

MEDICARE: GERALD PERNAK PA-C

MEDICARE: GERALD PERNAK PA-C

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
1	363A00000X	Physician Assistant	PA-465	AR
2	363A00000X	Physician Assistant	570	MT
3	363A00000X	Physician Assistant	5601004896	MI
4	363AM0700X	Medical Physician Assistant	PA.0005320	CO
5	363A00000X	Physician Assistant	PA.0005320	CO
6	363A00000X	Physician Assistant	PA21868	CA

General Provider Information

NPI Number	:	1760568018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERALD PERNAK PA-C

Provider Business Mailing Address
First Line	:	2695 ROCKY MOUNTAIN AVE
Second Line	:	STE 150
City	:	LOVELAND
State	:	CO
Zip	:	80538-9071
Country	:	US
Telephone Number	:	970-624-2412
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 MERCURY VILLAGE DR
Second Line	:
City	:	DURANGO
State	:	CO
Zip	:	81301-8955
Country	:	US
Telephone Number	:	970-335-2342
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/30/2006
Last Update Date	:	04/01/2025

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Directions to “ GERALD PERNAK PA-C” Practice Location

Language	Start Address	Practice Location

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