Healthcare Provider Details

I. General information

NPI: 1487653200
Provider Name (Legal Business Name): WILLIAM SCOTT TIMOTHY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 05/06/2021
Certification Date: 04/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 N TAYLOR ST
GUNNISON CO
81230-2243
US

IV. Provider business mailing address

PO BOX 3186
CRESTED BUTTE CO
81224-3186
US

V. Phone/Fax

Practice location:
  • Phone: 970-456-2711
  • Fax:
Mailing address:
  • Phone: 970-901-1165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number40654
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier8472524
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: