Provider Demographics
NPI:1871767954
Name:PADDACK, ANGELA COGBURN (MD)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:COGBURN
Last Name:PADDACK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:ANGELA
Other - Middle Name:CLAIRE
Other - Last Name:COGBURN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4745 ARAPAHOE AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-1082
Mailing Address - Country:US
Mailing Address - Phone:303-440-3073
Mailing Address - Fax:303-541-0807
Practice Address - Street 1:4745 ARAPAHOE AVE STE 200
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1082
Practice Address - Country:US
Practice Address - Phone:303-440-3073
Practice Address - Fax:303-541-0807
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-18
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-7983207Y00000X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology