Provider Demographics
NPI:1508284506
Name:VANADURONGVAN, TIMOTHY (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:VANADURONGVAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UROLOGICAL ASSOCIATES OF WESTERN COLORADO A DIV OF CSA
Mailing Address - Street 2:2373 G ROAD SUITE 200
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505-1006
Mailing Address - Country:US
Mailing Address - Phone:970-243-3061
Mailing Address - Fax:970-245-8269
Practice Address - Street 1:2373 G RD STE 200
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-1006
Practice Address - Country:US
Practice Address - Phone:970-243-0900
Practice Address - Fax:970-245-8369
Is Sole Proprietor?:No
Enumeration Date:2014-04-07
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0063676208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology