Provider Demographics
NPI:1235386798
Name:STEWART, TIMOTHY WILLIAM (PA)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:WILLIAM
Last Name:STEWART
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 E 1ST AVE
Mailing Address - Street 2:SUITE 307
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-2401
Mailing Address - Country:US
Mailing Address - Phone:303-428-6089
Mailing Address - Fax:303-412-2141
Practice Address - Street 1:340 E 1ST AVE
Practice Address - Street 2:DUITE 307
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-2401
Practice Address - Country:US
Practice Address - Phone:303-428-6089
Practice Address - Fax:303-412-2141
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1543174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1235386798OtherNPI
CO301300Medicare PIN