Provider Demographics
NPI:1841249083
Name:NEVRIVY, THOMAS E (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:E
Last Name:NEVRIVY
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 1:3519 RICHMOND DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-5995
Mailing Address - Country:US
Mailing Address - Phone:970-204-0300
Mailing Address - Fax:970-226-9041
Practice Address - Street 1:3519 RICHMOND DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-5995
Practice Address - Country:US
Practice Address - Phone:970-204-0300
Practice Address - Fax:970-226-9041
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO26918207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01269182Medicaid
COD24871Medicare UPIN
CO01269182Medicaid