Provider Demographics
NPI:1366406274
Name:COLT, TIMOTHY J (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:J
Last Name:COLT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3773 CHERRY CHERRY CREEK NORTH DRIVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209
Mailing Address - Country:US
Mailing Address - Phone:303-321-2273
Mailing Address - Fax:303-321-3641
Practice Address - Street 1:3773 CHERRY CHERRY CREEK NORTH DRIVE
Practice Address - Street 2:SUITE 101
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209
Practice Address - Country:US
Practice Address - Phone:303-321-2273
Practice Address - Fax:303-321-3641
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO27761174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO84136084500OtherPACIFICARE
COCOMMERCIALOther841360845
COF08198Medicare UPIN