Provider Demographics
NPI:1235901950
Name:SPEARS, TIMOTHY GORDON (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:GORDON
Last Name:SPEARS
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8770 CHASE DR APT 58
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80003-1060
Mailing Address - Country:US
Mailing Address - Phone:303-476-0640
Mailing Address - Fax:
Practice Address - Street 1:7951 W 65TH AVE
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80004-3318
Practice Address - Country:US
Practice Address - Phone:303-476-0640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAT.0001609207PS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports Medicine