Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 642 | CO |
NPI | 1033199070 |
---|---|
Provider Name | Dr. Tim Carlsen |
First Address | Colorado Springs, CO 80906-3981 |
Second Address | Colorado Springs, CO 80906-3981 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
12451576 | (05) | CO |
841469291005 | RMHMO (01) | CO |
84146929104 | PACIFICARE (01) | CO |
P00147284 | RRW MEDICARE (01) | CO |
U99211 | (02) | CO |