Provider Demographics
NPI:1538143235
Name:TIRRE, CONRAD J (MD)
Entity Type:Individual
Prefix:DR
First Name:CONRAD
Middle Name:J
Last Name:TIRRE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2535 S DOWNING ST
Mailing Address - Street 2:SUITE 440
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-5847
Mailing Address - Country:US
Mailing Address - Phone:303-832-3965
Mailing Address - Fax:303-957-5990
Practice Address - Street 1:2535 S DOWNING ST
Practice Address - Street 2:SUITE 440
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-5847
Practice Address - Country:US
Practice Address - Phone:303-832-3965
Practice Address - Fax:303-957-5990
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-06
Last Update Date:2015-08-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO314742082S0099X, 2082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01314749Medicaid
CO01314749Medicaid
KS102718Medicare PIN
COC488398Medicare PIN