MEDICARE: MR. PAUL KEEFER EDWARDS 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	PA0003558	CO

General Provider Information

NPI Number	:	1114902558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PAUL KEEFER EDWARDS PA-C

Provider Business Mailing Address
First Line	:	2142 DIAMOND CREEK DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80921-2986
Country	:	US
Telephone Number	:	850-855-7617
Fax Number	:

Provider Business Practice Location Address
First Line	:	4190 E WOODMEN RD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-8075
Country	:	US
Telephone Number	:	719-632-4455
Fax Number	:

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

Provider Enumeration Date	:	12/08/2005
Last Update Date	:	12/30/2020

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