Provider Demographics
NPI:1417945866
Name:NAGEL, TIMOTHY J (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:J
Last Name:NAGEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:TIM
Other - Middle Name:
Other - Last Name:NAGEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4943 STATE HIGHWAY 52 STE 240
Mailing Address - Street 2:
Mailing Address - City:DACONO
Mailing Address - State:CO
Mailing Address - Zip Code:80514-9107
Mailing Address - Country:US
Mailing Address - Phone:303-501-2600
Mailing Address - Fax:
Practice Address - Street 1:4943 STATE HIGHWAY 52
Practice Address - Street 2:
Practice Address - City:DACONO
Practice Address - State:CO
Practice Address - Zip Code:80514-9100
Practice Address - Country:US
Practice Address - Phone:303-501-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA24980207Q00000X
CO35545207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A02773Medicare UPIN
I2043Medicare ID - Type Unspecified
I2043Medicare ID - Type Unspecified
426006268OtherTAX ID WRIGHT MEDICAL CEN