Provider Demographics
NPI:1467448340
Name:CRISMAN, THOMAS STEPHEN (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:STEPHEN
Last Name:CRISMAN
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2253 DOWNING ST.
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205
Mailing Address - Country:US
Mailing Address - Phone:720-708-3471
Mailing Address - Fax:720-708-3495
Practice Address - Street 1:2253 DOWNING ST.
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205
Practice Address - Country:US
Practice Address - Phone:720-708-3471
Practice Address - Fax:720-708-3495
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO31855207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01318559Medicaid
COG24596Medicare UPIN
CO01318559Medicaid