Healthcare Provider Details

I. General information

NPI: 1174592927
Provider Name (Legal Business Name): PAUL K. TREADWELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 10/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 N PECOS RD
HENDERSON NV
89074-7319
US

IV. Provider business mailing address

2160 COLONIAL BLVD
FORT MYERS FL
33907-1410
US

V. Phone/Fax

Practice location:
  • Phone: 702-990-4767
  • Fax: 702-990-4766
Mailing address:
  • Phone: 239-931-7342
  • Fax: 239-931-7385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number7659
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: