Healthcare Provider Details

I. General information

NPI: 1205028370
Provider Name (Legal Business Name): CONRAD J TIRRE M D P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 10/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1578 HUMBOLDT ST
DENVER CO
80218-1638
US

IV. Provider business mailing address

1578 HUMBOLDT ST
DENVER CO
80218-1638
US

V. Phone/Fax

Practice location:
  • Phone: 303-830-7200
  • Fax: 303-830-7523
Mailing address:
  • Phone: 303-830-7200
  • Fax: 303-830-7523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number031474
License Number StateCO

VIII. Authorized Official

Name: DR. CONRAD J TIRRE
Title or Position: SELF
Credential: MD
Phone: 303-830-7200