Provider Demographics
NPI:1043404817
Name:FAKOOR SEVVOM, VAHEED WESTON (PA-C)
Entity Type:Individual
Prefix:MR
First Name:VAHEED
Middle Name:WESTON
Last Name:FAKOOR SEVVOM
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5387 MANHATTAN CIR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-4284
Mailing Address - Country:US
Mailing Address - Phone:303-494-7773
Mailing Address - Fax:303-494-1104
Practice Address - Street 1:5387 MANHATTAN CIR
Practice Address - Street 2:SUITE 200
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-4284
Practice Address - Country:US
Practice Address - Phone:303-494-7773
Practice Address - Fax:303-494-1104
Is Sole Proprietor?:No
Enumeration Date:2007-09-04
Last Update Date:2010-02-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO2706363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO72327715Medicaid
COCO303176Medicare PIN