Provider Demographics
NPI:1972737781
Name:CRISLIP, TIMOTHY W (DPM)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:W
Last Name:CRISLIP
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7376 MCLAUGHLIN RD STE G
Mailing Address - Street 2:
Mailing Address - City:PEYTON
Mailing Address - State:CO
Mailing Address - Zip Code:80831-4719
Mailing Address - Country:US
Mailing Address - Phone:515-710-4213
Mailing Address - Fax:
Practice Address - Street 1:7376 MCLAUGHLIN RD STE G
Practice Address - Street 2:
Practice Address - City:PEYTON
Practice Address - State:CO
Practice Address - Zip Code:80831-4719
Practice Address - Country:US
Practice Address - Phone:515-710-4213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-07
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPOD.0000782213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery