Provider Demographics
NPI:1164425898
Name:ALLEN, TIMOTHY J (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:J
Last Name:ALLEN
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 1:2121 E HARMONY RD # 270
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-3402
Mailing Address - Country:US
Mailing Address - Phone:970-221-1993
Mailing Address - Fax:970-221-9170
Practice Address - Street 1:2121 E HARMONY RD # 270
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-3402
Practice Address - Country:US
Practice Address - Phone:970-221-1993
Practice Address - Fax:970-221-9170
Is Sole Proprietor?:No
Enumeration Date:2005-05-26
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO338952084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01338953Medicaid
CO130025962OtherRAILROAD MEDICARE
COC486938Medicare PIN
COG41471Medicare UPIN
CO01338953Medicaid