Healthcare Provider Details

I. General information

NPI: 1376838870
Provider Name (Legal Business Name): JOSHUA TIERNEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2011
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 ROCKY MOUNTAIN AVE STE 2200
LOVELAND CO
80538-9004
US

IV. Provider business mailing address

2500 ROCKY MOUNTAIN AVENUE SUITE 2200
LOVELAND CO
80538-9004
US

V. Phone/Fax

Practice location:
  • Phone: 970-203-7520
  • Fax: 970-203-7256
Mailing address:
  • Phone: 970-203-7520
  • Fax: 970-203-7256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberTL4017
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number49401
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberDR.0058445
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: