Provider Demographics
NPI:1942244926
Name:BOERSMA, TIMOTHY W (DO)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:W
Last Name:BOERSMA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:TIM
Other - Middle Name:W
Other - Last Name:BOERSMA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9071
Mailing Address - Country:US
Mailing Address - Phone:970-624-2417
Mailing Address - Fax:970-652-2927
Practice Address - Street 1:175 S UNION BLVD STE 350
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-3146
Practice Address - Country:US
Practice Address - Phone:719-633-5515
Practice Address - Fax:719-365-1307
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036126968207P00000X, 207Q00000X
CODR.0061598207Q00000X, 208D00000X
TXF3766207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX113686306Medicaid
TX1136863Medicaid
TX75-2616977-066OtherTRICARE
TX8DZ891OtherBCBS
TX8F5719OtherBCBS
CO9000173087Medicaid
TX113686305Medicaid
TXP01092668OtherRAIL ROAD
TX8A4547Medicare ID - Type Unspecified
TX1136863Medicaid
TX8G2102Medicare PIN
TX339556YMAFMedicare PIN