Healthcare Provider Details

I. General information

NPI: 1306952346
Provider Name (Legal Business Name): THOMAS PATRICK BERESFORD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 08/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 CLERMONT STREET (116)
DENVER CO
80220-0116
US

IV. Provider business mailing address

6410 S OLATHE ST
CENTENNIAL CO
80016-1034
US

V. Phone/Fax

Practice location:
  • Phone: 303-399-8020
  • Fax: 303-393-4683
Mailing address:
  • Phone: 303-690-9149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number33187
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number33187
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: