Individual
ALEJANDRO ELLIOTT COLMENERO I
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSPA, PA-C
Contact information
Practice address
21 HAYDEN BRIDGE WAY, SPRINGFIELD, OR 97477-1305
(541) 747-4300
(541) 747-0655
Mailing address
2280 MARCOLA RD, SPRINGFIELD, OR 97477-2594
(541) 747-4300
(541) 747-0655
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA183504
OR
363A00000X
Physician Assistant
—
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500726848
—
OR
Enumeration date
04/20/2017
Last updated
06/02/2021
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