Provider Demographics
NPI:1215228473
Name:HEACOCK, THOMAS THEODORE (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:THEODORE
Last Name:HEACOCK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:UCHEALTH PULMONOLOGY CLINIC
Mailing Address - Street 2:2121 E HARMONY ROAD SUITE 300
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-3403
Mailing Address - Country:US
Mailing Address - Phone:970-224-9102
Mailing Address - Fax:970-224-9112
Practice Address - Street 1:UCHEALTH PULMONOLOGY CLINIC
Practice Address - Street 2:2121 E HARMONY ROAD SUITE 300
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-3403
Practice Address - Country:US
Practice Address - Phone:970-224-9102
Practice Address - Fax:970-224-9112
Is Sole Proprietor?:No
Enumeration Date:2011-04-22
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA141859207RP1001X
CODR.0053921207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease