Individual
COLIN R HICKENLOOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
823 N SAN FRANCISCO ST STE A, FLAGSTAFF, AZ 86001-3265
(520) 244-0089
(520) 244-0089
Mailing address
900 N SWITZER CANYON DR APT 103, FLAGSTAFF, AZ 86001-4830
(907) 538-6776
(520) 244-0089
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
100369
MT
363A00000X
Physician Assistant
Primary
9219
AZ
363AM0700X
Medical Physician Assistant
PADA547
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1020179
—
AK
Enumeration date
05/31/2006
Last updated
08/12/2022
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