Healthcare Provider Details

I. General information

NPI: 1619985249
Provider Name (Legal Business Name): TODD WILLIAM BEATTY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 08/08/2023
Certification Date: 08/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6870 W 52ND AVE STE 207
ARVADA CO
80002-3953
US

IV. Provider business mailing address

3895 UPHAM STREET SUITE 201
WHEAT RIDGE CO
80033-4651
US

V. Phone/Fax

Practice location:
  • Phone: 303-487-0834
  • Fax: 303-487-0834
Mailing address:
  • Phone: 303-487-0834
  • Fax: 303-487-6932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number36189
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberDR.0036189
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: