MEDICARE: MATTHEW FOCAZIO PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA.0006767	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PA.0006767	OTHER	CO	STATE OF COLORADO BOARD OF MEDICINE

General Provider Information

NPI Number	:	1417520024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW FOCAZIO PA-C

Provider Business Mailing Address
First Line	:	3329 E BAYAUD AVE APT 509
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80209-3342
Country	:	US
Telephone Number	:	386-290-7028
Fax Number	:

Provider Business Practice Location Address
First Line	:	1325 S COLORADO BLVD STE 509
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80222-3320
Country	:	US
Telephone Number	:	303-321-0123
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2021
Last Update Date	:	07/21/2021

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