Healthcare Provider Details

I. General information

NPI: 1609216183
Provider Name (Legal Business Name): TIMOTHY A HADLEY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2013
Last Update Date: 05/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9224 TEDDY LN STE 200
LONE TREE CO
80124-6799
US

IV. Provider business mailing address

PO BOX 174468
DENVER CO
80217-4468
US

V. Phone/Fax

Practice location:
  • Phone: 303-790-1515
  • Fax: 303-790-1989
Mailing address:
  • Phone: 303-790-1515
  • Fax: 303-790-1989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberDR.0062170
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: