Provider Demographics
NPI:1063486835
Name:O'TOOLE, KEVIN J (DO, MPH)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:J
Last Name:O'TOOLE
Suffix:
Gender:M
Credentials:DO, MPH
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4674 SNOW MESA DR STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-8614
Mailing Address - Country:US
Mailing Address - Phone:970-495-8450
Mailing Address - Fax:970-297-7674
Practice Address - Street 1:4674 SNOW MESA DR STE 200
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-8614
Practice Address - Country:US
Practice Address - Phone:970-495-8450
Practice Address - Fax:970-297-7674
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA-1345-052083P0901X
CO319532083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I57599Medicare UPIN
343625501Medicare PIN