Healthcare Provider Details

I. General information

NPI: 1942244926
Provider Name (Legal Business Name): TIMOTHY W BOERSMA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TIM W BOERSMA DO

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 S UNION BLVD STE 350
COLORADO SPRINGS CO
80910-3146
US

IV. Provider business mailing address

2695 ROCKY MOUNTAIN AVE STE 150
LOVELAND CO
80538-9071
US

V. Phone/Fax

Practice location:
  • Phone: 719-633-5515
  • Fax: 719-365-1307
Mailing address:
  • Phone: 970-624-2417
  • Fax: 970-652-2927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberDR.0061598
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberF3766
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR.0061598
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036126968
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036126968
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: