Provider Demographics
NPI:1962408021
Name:ROE, ANNA T (PA-C)
Entity type:Individual
Prefix:MS
First Name:ANNA
Middle Name:T
Last Name:ROE
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:5450 WESTERN AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2709
Mailing Address - Country:US
Mailing Address - Phone:303-442-2395
Mailing Address - Fax:303-442-1073
Practice Address - Street 1:4743 ARAPAHOE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1113
Practice Address - Country:US
Practice Address - Phone:303-442-2395
Practice Address - Fax:303-442-1073
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2017-11-10
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Provider Licenses
StateLicense IDTaxonomies
CO878363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07008782Medicaid
CO07008782Medicaid
COS33436Medicare UPIN
COS33436Medicare UPIN