Provider Demographics
NPI:1285680538
Name:SOPER, TIMOTHY H (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:H
Last Name:SOPER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2315 E HARMONY RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-8620
Mailing Address - Country:US
Mailing Address - Phone:970-484-6700
Mailing Address - Fax:970-484-5723
Practice Address - Street 1:2315 E HARMONY RD
Practice Address - Street 2:SUITE 140
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-8620
Practice Address - Country:US
Practice Address - Phone:970-484-6700
Practice Address - Fax:970-484-5723
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO37639208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO90704771Medicaid
340017093Medicare PIN
63164Medicare PIN
COCOA107610Medicare PIN
CO90704771Medicaid