Individual
REED MARK SOUKUP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2001 S SHIELDS E101, FORT COLLINS, CO 80526-1872
(970) 493-5334
(970) 472-0638
Mailing address
2001 S SHIELDS E101, FORT COLLINS, CO 80526-1872
(970) 493-5334
(970) 472-0638
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA.0003792
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
43322743
—
CO
Enumeration date
09/27/2013
Last updated
10/10/2016
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