Provider Demographics
NPI:1699854653
Name:THIMSEN, DANIEL ALAN (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:ALAN
Last Name:THIMSEN
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 1:877 CANYON CREEK DR
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601-9732
Mailing Address - Country:US
Mailing Address - Phone:970-947-1156
Mailing Address - Fax:970-945-9138
Practice Address - Street 1:1830 BLAKE AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-4275
Practice Address - Country:US
Practice Address - Phone:970-945-1144
Practice Address - Fax:970-945-9138
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO36386174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01363860Medicaid
CO01363860Medicaid
CO421218Medicare ID - Type Unspecified