Provider Demographics
NPI:1669410833
Name:SULLINGER, TIMOTHY WAYNE (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:WAYNE
Last Name:SULLINGER
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 1:154 COLORADO AVE
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-3651
Mailing Address - Country:US
Mailing Address - Phone:970-252-9165
Mailing Address - Fax:970-252-8874
Practice Address - Street 1:154 COLORADO AVE
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-3651
Practice Address - Country:US
Practice Address - Phone:970-252-9165
Practice Address - Fax:970-252-8874
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN66433207Q00000X
CO39301207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO080180229OtherRAILROAD MEDICARE
CO65084730Medicaid
CO080180229OtherRAILROAD MEDICARE
COH28915Medicare UPIN