Healthcare Provider Details

I. General information

NPI: 1215939541
Provider Name (Legal Business Name): TIMOTHY J RODGERS M. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 11/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5920 MCINTYRE ST
GOLDEN CO
80403-7445
US

IV. Provider business mailing address

5920 MCINTYRE ST
GOLDEN CO
80403-7445
US

V. Phone/Fax

Practice location:
  • Phone: 303-949-1250
  • Fax:
Mailing address:
  • Phone: 303-949-1250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number45729
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: