Healthcare Provider Details

I. General information

NPI: 1992984025
Provider Name (Legal Business Name): TIMOTHY JOHN MCCOLLUM PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2007
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7261 S BROADWAY STE 103
LITTLETON CO
80122-8018
US

IV. Provider business mailing address

7261 S BROADWAY STE 103
LITTLETON CO
80122-8018
US

V. Phone/Fax

Practice location:
  • Phone: 303-358-5130
  • Fax: 720-510-2704
Mailing address:
  • Phone: 303-358-5130
  • Fax: 720-510-2704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number1684
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: