Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | CO29739 | CO |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | CO29739 | CO |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | CO29739 | CO |
NPI | 1275591539 |
---|---|
Provider Name | Dr. Timothy Sales O'brien |
First Address | Colorado Springs, CO 80907-4900 |
Second Address | Colorado Springs, CO 80907-4900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2006 |
Last Update Date | 13/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01297399 | (05) | CO |
E48254 | (02) | CO |
OBJ3038 | ANTHEM BCBS (01) | CO |