# COLORADO PROVIDER NETWORK LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1649851155
- **Authorized official:** JOHN MARQUEZ PA-C (CEO)
- **Authorized official phone:** (720) 320-3218

## Contact information

- **Practice address:** 1435 GARRISON ST STE 110, LAKEWOOD, CO 80215-4748
- **Practice address phone:** (720) 241-3765
- **Mailing address:** PO BOX 12375, DENVER, CO 80212-0375
- **Mailing address phone:** (303) 668-5231
- **Mailing address fax:** (720) 358-5897

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QA0505X | Adult Medicine Physician | — | NULL | Yes |
| 207QA0505X | Adult Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/16/2021
- **Last updated:** 06/23/2023