MEDICARE: TIMOTHY VANADURONGVAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	DR.0063676	CO

General Provider Information

NPI Number	:	1508284506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY VANADURONGVAN M.D.

Provider Business Mailing Address
First Line	:	UROLOGICAL ASSOCIATES OF WESTERN COLORADO A DIV OF CSA
Second Line	:	2373 G ROAD SUITE 200
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81505-1006
Country	:	US
Telephone Number	:	970-243-3061
Fax Number	:	970-245-8269

Provider Business Practice Location Address
First Line	:	2373 G RD STE 200
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81505-1006
Country	:	US
Telephone Number	:	970-243-0900
Fax Number	:	970-245-8369

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2014
Last Update Date	:	02/11/2021

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