Organization
MOUNTAIN SURGICAL ASSOCIATES PC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARC ANTHONY VETRI (MANAGING PARTNER)
(970) 799-1840
Entity
Organization
Contact information
Practice address
10 TOWN PLZ, SUITE 81, DURANGO, CO 81301-5104
(970) 799-1840
(970) 385-4350
Mailing address
10 TOWN PLZ, SUITE 81, DURANGO, CO 81301-5104
(970) 799-1840
(970) 385-4350
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA1741
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA1741
COLORADO MEDICAL LICENSE
CO
Enumeration date
02/11/2009
Last updated
02/24/2009
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