Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 20508 | CO |
Y | 208600000X | Surgeon | 20508 | CO |
NPI | 1023056173 |
---|---|
Provider Name | Dr. Paul Raymond Radway |
First Address | Pueblo, CO 81005-3916 |
Second Address | Pueblo, CO 81005-3916 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2006 |
Last Update Date | 27/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02974278 | (05) | CO |
D23794 | (02) | CO |