Individual
MELBURN GARRETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3744 S TIMBERLINE RD, FORT COLLINS, CO 80525-4333
(970) 495-0506
Mailing address
3744 S TIMBERLINE RD STE 102, FORT COLLINS, CO 80525-4334
(970) 495-0506
(970) 495-0485
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA.0006441
CO
363A00000X
Physician Assistant
PA9109576
FL
363AM0700X
Medical Physician Assistant
PA9109576
FL
363AS0400X
Surgical Physician Assistant
PA9109576
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003179847A
—
GA
05
—
017896300
—
FL
Enumeration date
06/10/2016
Last updated
10/12/2021
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