NPI 1104178045 · Physician Assistant · Anthem
Carrier listings present but Colorado DORA license appears expired or revoked.
NPPES
THORNTON, 80229
Freshness: Unknown
Network Status
Listed with 3 carriers
DORA License
Expired
Medicare
143 services
79 beneficiaries
$6,417.17 total payment
Specialty: Physician Assistant
Care Compare
No Care Compare data
PECOS Enrollment
Medicare enrolled
Order/Referring eligible: Yes
Active NPI with specialty classification
DORA license expired or revoked
Active Medicare billing confirmed
Single address source (NPPES)
Limited carrier network presence
3 networks across 3 carriers
Disclaimer: This analysis uses publicly available federal and state data sources. It does not constitute a determination of provider status or network participation. Contact the provider or health plan directly to verify current status.