Individual
DR. MARK PETRUN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2121 E HARMONY RD, STE 300, FORT COLLINS, CO 80528-3400
(970) 224-9102
(970) 224-9112
Mailing address
2121 E HARMONY RD, SUITE 300, FORT COLLINS, CO 80528-3400
(970) 224-9102
(970) 224-9112
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
DR.0024745
CO
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
DR.0024745
CO
207RP1001X
Pulmonary Disease Physician
Primary
DR.0024745
CO
207RS0012X
Sleep Medicine (Internal Medicine) Physician
DR.0024745
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01247451
—
CO
05
—
104364100
—
WY
01
—
290007464
RAILROAD MEDICARE
CO
Enumeration date
01/24/2006
Last updated
08/16/2016
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