Provider Demographics
NPI:1619985249
Name:BEATTY, TODD WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:WILLIAM
Last Name:BEATTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3895 UPHAM STREET
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-4651
Mailing Address - Country:US
Mailing Address - Phone:303-487-0834
Mailing Address - Fax:303-487-6932
Practice Address - Street 1:6870 W 52ND AVE STE 207
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80002-3953
Practice Address - Country:US
Practice Address - Phone:303-487-0834
Practice Address - Fax:303-487-0834
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO36189174400000X
CODR.0036189207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01361898Medicaid
CO454518Medicare PIN
CO01361898Medicaid