Provider Demographics
NPI:1386734457
Name:PINGREE, TIMOTHY FREDERICK (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:FREDERICK
Last Name:PINGREE
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 1:10099 RIDGEGATE PKWY
Mailing Address - Street 2:SUITE 230
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-5531
Mailing Address - Country:US
Mailing Address - Phone:303-706-1616
Mailing Address - Fax:303-706-0177
Practice Address - Street 1:10099 RIDGEGATE PKWY
Practice Address - Street 2:SUITE 230
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5531
Practice Address - Country:US
Practice Address - Phone:303-706-1616
Practice Address - Fax:303-706-0177
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO31455207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01314558Medicaid
CO800238Medicare ID - Type Unspecified
CO01314558Medicaid