Individual
CHARLES ETTELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1601 E 19TH AVE STE 3300, DENVER, CO 80218-1239
(303) 837-0072
Mailing address
10350 E DAKOTA AVE, DENVER, CO 80247-1314
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA.0004077
CO
363AS0400X
Surgical Physician Assistant
—
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
027032
KAISER COMMERCIAL NUMBER
CO
05
—
83875344
—
CO
Enumeration date
08/28/2014
Last updated
01/04/2022
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