Healthcare Provider Details

I. General information

NPI: 1104147453
Provider Name (Legal Business Name): DAVID P THEIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2010
Last Update Date: 08/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 CHAPEL HILLS DR STE 201
COLORADO SPRINGS CO
80920-1056
US

IV. Provider business mailing address

595 CHAPEL HILLS DRIVE SUITE 201
COLORADO SPRINGS CO
80920
US

V. Phone/Fax

Practice location:
  • Phone: 719-475-9613
  • Fax: 719-475-9539
Mailing address:
  • Phone: 719-475-9613
  • Fax: 719-475-9539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberOS017698
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberDR.0058799
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: