Provider Demographics
NPI:1285886887
Name:FEDOR, ERIK W (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MR
First Name:ERIK
Middle Name:W
Last Name:FEDOR
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
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Mailing Address - Street 1:3550 LUTHERAN PARKWAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033
Mailing Address - Country:US
Mailing Address - Phone:303-425-9900
Mailing Address - Fax:303-425-0883
Practice Address - Street 1:3550 LUTHERAN PARKWAY
Practice Address - Street 2:SUITE 200
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033
Practice Address - Country:US
Practice Address - Phone:303-425-9900
Practice Address - Fax:303-425-0883
Is Sole Proprietor?:No
Enumeration Date:2008-10-15
Last Update Date:2023-03-07
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1532OtherPA LICENSE
CO1532OtherPA LICENSE