Healthcare Provider Details

I. General information

NPI: 1245157924
Provider Name (Legal Business Name): THAW DAR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 N 66TH AVE
GREELEY CO
80634-9935
US

IV. Provider business mailing address

317 N 66TH AVE
GREELEY CO
80634-9935
US

V. Phone/Fax

Practice location:
  • Phone: 336-688-8924
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: