Provider Demographics
NPI:1831153345
Name:FONKEN, PAUL W (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:W
Last Name:FONKEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:131 STANLEY AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ESTES PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80517-6363
Mailing Address - Country:US
Mailing Address - Phone:970-586-2343
Mailing Address - Fax:970-586-9060
Practice Address - Street 1:131 STANLEY AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:ESTES PARK
Practice Address - State:CO
Practice Address - Zip Code:80517-6363
Practice Address - Country:US
Practice Address - Phone:970-586-2343
Practice Address - Fax:970-586-9060
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2017-01-03
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Provider Licenses
StateLicense IDTaxonomies
CO28920207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01289206Medicaid
CO331016YLB8Medicare PIN
COE40376Medicare UPIN
COC802655Medicare PIN
BF6387840OtherDEA