Provider Demographics
NPI:1023152212
Name:ABBOTT, TIMOTHY WILLIAM (PA-C)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:WILLIAM
Last Name:ABBOTT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1677 S GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-3005
Mailing Address - Country:US
Mailing Address - Phone:303-715-9176
Mailing Address - Fax:
Practice Address - Street 1:1677 S GARFIELD ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-3005
Practice Address - Country:US
Practice Address - Phone:303-715-9176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health