Provider Demographics
NPI:1639206642
Name:MOSER, TIMOTHY GERALD (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:GERALD
Last Name:MOSER
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:PO BOX 140230
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:CO
Mailing Address - Zip Code:80214
Mailing Address - Country:US
Mailing Address - Phone:720-440-4004
Mailing Address - Fax:
Practice Address - Street 1:2110 OSCEOLA ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80212
Practice Address - Country:US
Practice Address - Phone:720-440-4004
Practice Address - Fax:720-633-9094
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO36717207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
012718OtherKAISER-COMMERCIAL NUMBER
CO27121232Medicaid
COCK11159Medicare PIN
012718OtherKAISER-COMMERCIAL NUMBER
COCO307530Medicare PIN