Basic Information
| Provider Information | |||||||||
| NPI: | 1437118387 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TWARDOWSKI | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | A | ||||||||
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| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1727 | ||||||||
| Address2: | |||||||||
| City: | GRAND JCT | ||||||||
| State: | CO | ||||||||
| PostalCode: | 815021727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702417600 | ||||||||
| FaxNumber: | 9702634831 | ||||||||
| Practice Location | |||||||||
| Address1: | 743 HORIZON CT | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | GRAND JUNCTION | ||||||||
| State: | CO | ||||||||
| PostalCode: | 815068701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702417600 | ||||||||
| FaxNumber: | 9702634831 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2006 | ||||||||
| LastUpdateDate: | 10/01/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 31690 | CO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | BT1903245 | 01 | CO | DEA | OTHER | 1316900 | 05 | CO | MEDICAID | 31690 | 01 | CO | COLORADO BOARD ME | OTHER |