Provider Demographics
NPI:1093946337
Name:PAINTER, MILFORD RAY JR
Entity Type:Individual
Prefix:
First Name:MILFORD
Middle Name:RAY
Last Name:PAINTER
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2635 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-2230
Mailing Address - Country:US
Mailing Address - Phone:877-320-1692
Mailing Address - Fax:
Practice Address - Street 1:2635 WALNUT ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-2230
Practice Address - Country:US
Practice Address - Phone:877-320-1692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO16390208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
COD23056Medicare UPIN