Provider Demographics
NPI:1447455852
Name:ELDRIDGE, TIMOTHY JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:JAMES
Last Name:ELDRIDGE
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1080 S SABLE BLVD
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-3796
Mailing Address - Country:US
Mailing Address - Phone:303-552-9577
Mailing Address - Fax:415-252-7176
Practice Address - Street 1:1080 S SABLE BLVD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-3796
Practice Address - Country:US
Practice Address - Phone:303-552-9577
Practice Address - Fax:415-252-7176
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO49243207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO58733256Medicaid
CO49243OtherSTATE LICENSE NUMBER
CO028509OtherKAISER COMMERCIAL NUMBER