Provider Demographics
NPI:1982669388
Name:DVIRNAK, PAUL D (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:D
Last Name:DVIRNAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 RIVERGATE LANE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301
Mailing Address - Country:US
Mailing Address - Phone:970-259-3020
Mailing Address - Fax:970-259-9766
Practice Address - Street 1:575 RIVERGATE LANE
Practice Address - Street 2:SUITE 105
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301
Practice Address - Country:US
Practice Address - Phone:970-259-3020
Practice Address - Fax:970-259-9766
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO35316207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01353168Medicaid
6353970001Medicare NSC
G29270Medicare UPIN
24161Medicare ID - Type Unspecified