Healthcare Provider Details

I. General information

NPI: 1093005738
Provider Name (Legal Business Name): TIMOTHY VICTOR WAXWEILER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2011
Last Update Date: 12/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 BOB PETERS GRV RADIATION ONCOLOGY
COLORADO SPRINGS CO
80950-0001
US

IV. Provider business mailing address

525 BOB PETERS GRV 4080 BRIARGATE PARKWAY
COLORADO SPRINGS CO
80950-0001
US

V. Phone/Fax

Practice location:
  • Phone: 719-365-6800
  • Fax:
Mailing address:
  • Phone: 719-365-6800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberDR.0056707
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: