Provider Demographics
NPI:1124336169
Name:TIMOTHY J CAWLFIELD, MD, PLLC
Entity type:Organization
Organization Name:TIMOTHY J CAWLFIELD, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:CAWLFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-543-9158
Mailing Address - Street 1:41 MONTEBELLO RD STE 210
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81001-1366
Mailing Address - Country:US
Mailing Address - Phone:719-543-9158
Mailing Address - Fax:719-544-1958
Practice Address - Street 1:41 MONTEBELLO RD STE 210
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81001-1379
Practice Address - Country:US
Practice Address - Phone:719-543-9158
Practice Address - Fax:719-544-1958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-23
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO44041207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO35076852Medicaid
CODR4619OtherRAIL ROAD MEDICARE
CO35076852Medicaid