Provider Demographics
NPI:1033108915
Name:HURTADO, TIMOTHY RAY (DO)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:RAY
Last Name:HURTADO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2222 N NEVADA AVE
Mailing Address - Street 2:FRONT RANGE EMERGENCY SPECIALISTS
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-6819
Mailing Address - Country:US
Mailing Address - Phone:719-475-0299
Mailing Address - Fax:719-475-0414
Practice Address - Street 1:2222 N NEVADA AVE
Practice Address - Street 2:FRONT RANGE EMERGENCY SPECIALISTS
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-6819
Practice Address - Country:US
Practice Address - Phone:719-475-0299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE285207P00000X
CO45777207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO24525006Medicaid
COCO307577Medicare PIN
CO24525006Medicaid