Healthcare Provider Details

I. General information

NPI: 1891175501
Provider Name (Legal Business Name): THOMAS JULIAN KRASNY ERGEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2015
Last Update Date: 01/18/2022
Certification Date: 08/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12631 E 17TH AVE OFC 1
AURORA CO
80045-2527
US

IV. Provider business mailing address

12631 E 17TH AVE OFC 1B202
AURORA CO
80045-2527
US

V. Phone/Fax

Practice location:
  • Phone: 303-724-7378
  • Fax: 803-434-4183
Mailing address:
  • Phone: 865-385-7424
  • Fax: 803-434-4183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberDR0064422
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: