MEDICARE: DR. PAUL FAWSON D.P.M.

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	213ES0103X	Foot & Ankle Surgery Podiatrist	POD.0000762	CO

General Provider Information

NPI Number	:	1467715557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL FAWSON D.P.M.

Provider Business Mailing Address
First Line	:	3435 RIDING HOOD CT
Second Line	:
City	:	CASTLE ROCK
State	:	CO
Zip	:	80109-3690
Country	:	US
Telephone Number	:	801-368-3859
Fax Number	:

Provider Business Practice Location Address
First Line	:	7505 VILLAGE SQUARE DR
Second Line	:	SUITE 101
City	:	CASTLE PINES
State	:	CO
Zip	:	80108-3692
Country	:	US
Telephone Number	:	303-805-5156
Fax Number	:	303-805-5157

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

Provider Enumeration Date	:	06/22/2012
Last Update Date	:	08/17/2015

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