Provider Demographics
NPI:1710905534
Name:FLIPPEN, PAUL RANDOLPH (PA)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:RANDOLPH
Last Name:FLIPPEN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 N CEDAR BROOK RD
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-0415
Mailing Address - Country:US
Mailing Address - Phone:303-443-1020
Mailing Address - Fax:
Practice Address - Street 1:1420 W MIDWAY BLVD
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-2090
Practice Address - Country:US
Practice Address - Phone:303-466-1866
Practice Address - Fax:303-466-4081
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00070363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO512958Medicare ID - Type Unspecified
COQ00131Medicare UPIN