Provider Demographics
NPI:1316990914
Name:VETRI, MARC ANTHONY (PA-C)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:ANTHONY
Last Name:VETRI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1903 W 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-5007
Mailing Address - Country:US
Mailing Address - Phone:970-799-1840
Mailing Address - Fax:
Practice Address - Street 1:1903 W 2ND AVE
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5007
Practice Address - Country:US
Practice Address - Phone:970-799-1840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1741363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COS82646Medicare UPIN