Provider Demographics
NPI:1205028370
Name:CONRAD J TIRRE M D P C
Entity Type:Organization
Organization Name:CONRAD J TIRRE M D P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SELF
Authorized Official - Prefix:DR
Authorized Official - First Name:CONRAD
Authorized Official - Middle Name:J
Authorized Official - Last Name:TIRRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-830-7200
Mailing Address - Street 1:1578 HUMBOLDT ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1638
Mailing Address - Country:US
Mailing Address - Phone:303-830-7200
Mailing Address - Fax:303-830-7523
Practice Address - Street 1:1578 HUMBOLDT ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1638
Practice Address - Country:US
Practice Address - Phone:303-830-7200
Practice Address - Fax:303-830-7523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO031474208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01314749Medicaid
COF90191Medicare UPIN
CO01314749Medicaid
NENA1165Medicare PIN
COC488388Medicare PIN