Individual
MR. JONATHAN GRAVGAARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3630 SINTON RD STE 100, COLORADO SPRINGS, CO 80907-5072
(719) 359-8812
Mailing address
831 WEBER RIDGE PT, COLORADO SPRINGS, CO 80903-7000
(678) 468-3068
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
2396
SC
363AM0700X
Medical Physician Assistant
Primary
PA.0004875
CO
Other
Enumeration date
08/04/2015
Last updated
03/20/2024
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