Provider Demographics
NPI:1962436287
Name:PAVOL, BRISTOL (PA)
Entity type:Individual
Prefix:
First Name:BRISTOL
Middle Name:
Last Name:PAVOL
Suffix:
Gender:
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:PO BOX 35380
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-5380
Mailing Address - Country:US
Mailing Address - Phone:719-463-5600
Mailing Address - Fax:
Practice Address - Street 1:1687 COLE BLVD
Practice Address - Street 2:STE 155
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80401-3318
Practice Address - Country:US
Practice Address - Phone:303-785-5992
Practice Address - Fax:720-284-0499
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO946363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant