Provider Demographics
NPI:1689793812
Name:SAFFORD, PAUL WHITNEY (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:WHITNEY
Last Name:SAFFORD
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:582 CATALINA DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-5141
Mailing Address - Country:US
Mailing Address - Phone:719-287-2627
Mailing Address - Fax:
Practice Address - Street 1:600 WEST 16TH ST
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003
Practice Address - Country:US
Practice Address - Phone:719-542-7222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1094363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1094OtherSTATE LICENSE
CO1094OtherSTATE LICENSE