MEDICARE: BROOKE T PACKARD PA

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.0002000	CO
2	207P00000X	Emergency Medicine Physician	2000	CO

Other Identifiers

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

General Provider Information

NPI Number	:	1770557993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKE T PACKARD PA

Provider Business Mailing Address
First Line	:	7851 S ELATI ST
Second Line	:	SUITE 202
City	:	LITTLETON
State	:	CO
Zip	:	80120-8080
Country	:	US
Telephone Number	:	303-759-0854
Fax Number	:	303-759-0864

Provider Business Practice Location Address
First Line	:	4231 W 16TH AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80204-1335
Country	:	US
Telephone Number	:	303-629-3721
Fax Number	:	303-629-2192

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

Provider Enumeration Date	:	02/14/2006
Last Update Date	:	01/31/2025

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