Healthcare Provider Details

I. General information

NPI: 1063486835
Provider Name (Legal Business Name): KEVIN J O'TOOLE DO, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 07/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4674 SNOW MESA DR STE 200
FORT COLLINS CO
80528-8614
US

IV. Provider business mailing address

4674 SNOW MESA DR STE 200
FORT COLLINS CO
80528-8614
US

V. Phone/Fax

Practice location:
  • Phone: 970-495-8450
  • Fax: 970-297-7674
Mailing address:
  • Phone: 970-495-8450
  • Fax: 970-297-7674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberA-1345-05
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number31953
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: