Provider Demographics
NPI:1306988126
Name:KRUSE, TIMOTHY RICHARD (MD)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:RICHARD
Last Name:KRUSE
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Gender:M
Credentials:MD
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Mailing Address - Street 1:711 E VALLEY RD
Mailing Address - Street 2:UNIT 202C
Mailing Address - City:BASALT
Mailing Address - State:CO
Mailing Address - Zip Code:81621-8370
Mailing Address - Country:US
Mailing Address - Phone:970-927-8563
Mailing Address - Fax:970-300-2883
Practice Address - Street 1:711 E VALLEY RD
Practice Address - Street 2:UNIT 202C
Practice Address - City:BASALT
Practice Address - State:CO
Practice Address - Zip Code:81621-8370
Practice Address - Country:US
Practice Address - Phone:970-927-8563
Practice Address - Fax:970-300-2883
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2015-09-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO37271-CO207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine