Provider Demographics
NPI:1205872355
Name:BATTLE, PAUL J (PAC)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:J
Last Name:BATTLE
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4900 S MONACO ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3486
Mailing Address - Country:US
Mailing Address - Phone:303-865-7800
Mailing Address - Fax:303-865-7804
Practice Address - Street 1:1721 E 19TH AVE
Practice Address - Street 2:# 434
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1251
Practice Address - Country:US
Practice Address - Phone:303-865-7800
Practice Address - Fax:303-865-7804
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2022-01-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
363AM0700X, 363AS0400X
CO798363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO45977348Medicaid
CO45977348Medicaid
COS12736Medicare UPIN