Provider Demographics
NPI:1578561874
Name:RAFORD, PAUL T (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:T
Last Name:RAFORD
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1252
Mailing Address - Street 2:
Mailing Address - City:CONIFER
Mailing Address - State:CO
Mailing Address - Zip Code:80433-1252
Mailing Address - Country:US
Mailing Address - Phone:303-250-0714
Mailing Address - Fax:
Practice Address - Street 1:7030 S YOSEMITE ST
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-2016
Practice Address - Country:US
Practice Address - Phone:303-721-9984
Practice Address - Fax:303-267-7304
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL74479207Q00000X, 2083P0500X
CO348162083P0500X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO020147OtherKAISER COMMERICAL NUMBER
CO13379526Medicaid
CO811064OtherMEDICARE GROUP NUMBER
CO348308OtherMEDICARE GROUP NUMBER
CO811064OtherMEDICARE GROUP NUMBER
CO804206Medicare PIN
CO295214YL7XMedicare PIN
CO811649Medicare PIN
CO020147OtherKAISER COMMERICAL NUMBER