Healthcare Provider Details

I. General information

NPI: 1427151877
Provider Name (Legal Business Name): MAURICE JUDE ROMEO FAUVEL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 02/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 HWY 72 WEST POB 550
NEDERLAND CO
80466
US

IV. Provider business mailing address

PO BOX 550 159 HWY 72 W
NEDERLAND CO
80466-0550
US

V. Phone/Fax

Practice location:
  • Phone: 303-258-9355
  • Fax: 303-258-9356
Mailing address:
  • Phone: 303-258-9355
  • Fax: 303-258-9356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35947
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: