Provider Demographics
NPI:1093005738
Name:WAXWEILER, TIMOTHY VICTOR (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:VICTOR
Last Name:WAXWEILER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 BOB PETERS GRV
Mailing Address - Street 2:4080 BRIARGATE PARKWAY
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80950-0001
Mailing Address - Country:US
Mailing Address - Phone:719-365-6800
Mailing Address - Fax:
Practice Address - Street 1:525 BOB PETERS GRV
Practice Address - Street 2:RADIATION ONCOLOGY
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80950-0001
Practice Address - Country:US
Practice Address - Phone:719-365-6800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-14
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.00567072085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology