Healthcare Provider Details

I. General information

NPI: 1740867183
Provider Name (Legal Business Name): WILLIAM TYLER PRINCE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 BANNOCK ST MC0108
DENVER CO
80204
US

IV. Provider business mailing address

777 BANNOCK ST MC0108
DENVER CO
80204
US

V. Phone/Fax

Practice location:
  • Phone: 303-602-5193
  • Fax:
Mailing address:
  • Phone: 303-602-5193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0073233
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: