Provider Demographics
NPI:1215487731
Name:KLAWONN, ADAM FORREST (PA)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:FORREST
Last Name:KLAWONN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:151 W LAKE ST FL 3
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-4111
Mailing Address - Country:US
Mailing Address - Phone:970-491-7121
Mailing Address - Fax:970-491-4158
Practice Address - Street 1:151 W LAKE ST FL 3
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-4111
Practice Address - Country:US
Practice Address - Phone:970-491-7121
Practice Address - Fax:970-491-4158
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-07
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO6795363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty