Provider Demographics
NPI:1861443442
Name:TYNAN, GERLINDE S (MD)
Entity Type:Individual
Prefix:
First Name:GERLINDE
Middle Name:S
Last Name:TYNAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1760 E KEN PRATT BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80504-5311
Mailing Address - Country:US
Mailing Address - Phone:303-684-1877
Mailing Address - Fax:303-267-4431
Practice Address - Street 1:1760 E KEN PRATT BLVD STE 301
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80504-5311
Practice Address - Country:US
Practice Address - Phone:303-684-1877
Practice Address - Fax:303-267-4431
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ35511208600000X
CODR.0051883208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZI58383Medicare UPIN
AZ118768Medicare PIN