MEDICARE: DR. PAUL RAYMOND RADWAY M.D.

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	208600000X	Surgery Physician	20508	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023056173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL RAYMOND RADWAY M.D.

Provider Business Mailing Address
First Line	:	3506 SAN JOSE CT
Second Line	:
City	:	PUEBLO
State	:	CO
Zip	:	81005-3916
Country	:	US
Telephone Number	:	719-252-6467
Fax Number	:

Provider Business Practice Location Address
First Line	:	3506 SAN JOSE CT
Second Line	:
City	:	PUEBLO
State	:	CO
Zip	:	81005-3916
Country	:	US
Telephone Number	:	719-252-6467
Fax Number	:

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

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	02/27/2015

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