Individual
KEVIN HATTAWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
525 HATHAWAY STREET, FAIRPLAY, CO 80440
(303) 788-9220
Mailing address
525 HATHAWAY STREET, FAIRPLAY, CO 80440
(303) 788-9220
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
30152
TN
207Q00000X
Family Medicine Physician
Primary
DR.0049308
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3150572
BCBS
—
Enumeration date
03/26/2007
Last updated
07/26/2019
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