Provider Demographics
NPI:1154564912
Name:HASSETT, PAUL ALEXANDER
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:ALEXANDER
Last Name:HASSETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:PAUL
Other - Middle Name:ALEXANDER
Other - Last Name:HASSETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5200 DTC PKWY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2709
Mailing Address - Country:US
Mailing Address - Phone:303-745-0000
Mailing Address - Fax:
Practice Address - Street 1:5200 DTC PKWY
Practice Address - Street 2:SUITE 400
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2709
Practice Address - Country:US
Practice Address - Phone:303-745-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-09
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8147926-1204207R00000X
CO0052396207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO63129574Medicaid
CO290392YLMEMedicare PIN