Provider Demographics
NPI:1073605234
Name:THIEL, ROBERT ALFRED (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ALFRED
Last Name:THIEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 W 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MORGAN
Mailing Address - State:CO
Mailing Address - Zip Code:80701-2012
Mailing Address - Country:US
Mailing Address - Phone:970-867-5681
Mailing Address - Fax:970-867-7361
Practice Address - Street 1:102 W 9TH AVE
Practice Address - Street 2:
Practice Address - City:FORT MORGAN
Practice Address - State:CO
Practice Address - Zip Code:80701-2012
Practice Address - Country:US
Practice Address - Phone:970-867-5681
Practice Address - Fax:970-867-7361
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO31684207Q00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01316843Medicaid
A73082Medicare UPIN
C22088Medicare PIN