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General NPI Number Information
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NPI Number | 1538843883
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Entity Type | Organization
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Legal Business Name | BRO - CENTENNIAL LLC
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Dates
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Enumeration Date | 06/14/2023
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Last Update Date | 06/14/2023
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Provider Practice Location Address
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Address Line | 5161 E ARAPAHOE RD STE 250
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City | CENTENNIAL
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State | CO
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Zip | 80122-4810
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Country | US
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Telephone | 720-463-0567
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Fax | 303-494-5371
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Provider Business Mailing Address
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Address Line | 5420 ARAPAHOE AVE STE A
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City | BOULDER
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State | CO
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Zip | 80303-1250
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Country | US
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Telephone | 720-463-0567
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Fax | 303-494-5371
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Authorized Official
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Title or Position | SOLE OWNER
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Name | DR. TIMOTHY J MAZZOLA
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Credential | MD
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Telephone | 720-463-0567
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number |
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License Number State |
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