Provider Demographics
NPI:1386309821
Name:HASKELL, ERIC MATTHEW (PA-C)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:MATTHEW
Last Name:HASKELL
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 1:3231 S RACE ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-3033
Mailing Address - Country:US
Mailing Address - Phone:303-653-4220
Mailing Address - Fax:
Practice Address - Street 1:1906 BLAKE AVE
Practice Address - Street 2:
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-4227
Practice Address - Country:US
Practice Address - Phone:970-384-7090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-31
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0007158207X00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery