Healthcare Provider Details

I. General information

NPI: 1033108915
Provider Name (Legal Business Name): TIMOTHY RAY HURTADO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 11/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 N NEVADA AVE FRONT RANGE EMERGENCY SPECIALISTS
COLORADO SPRINGS CO
80907-6819
US

IV. Provider business mailing address

2222 N NEVADA AVE FRONT RANGE EMERGENCY SPECIALISTS
COLORADO SPRINGS CO
80907-6819
US

V. Phone/Fax

Practice location:
  • Phone: 719-475-0299
  • Fax:
Mailing address:
  • Phone: 719-475-0299
  • Fax: 719-475-0414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number285
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number45777
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: