Provider Demographics
NPI:1114942570
Name:TIMMONS, CHRISTENE ANN (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTENE
Middle Name:ANN
Last Name:TIMMONS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7587 SOLITUDE LN
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-2909
Mailing Address - Country:US
Mailing Address - Phone:719-534-9665
Mailing Address - Fax:
Practice Address - Street 1:1400 E BOULDER ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5533
Practice Address - Country:US
Practice Address - Phone:719-365-5808
Practice Address - Fax:719-365-6908
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO28233207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO32404085Medicaid
COE46281Medicare UPIN
COC807075Medicare PIN
COP00367430Medicare PIN