Provider Demographics
NPI:1720172059
Name:NING, THEODORE CLIFFORD JR (MD)
Entity type:Individual
Prefix:
First Name:THEODORE
Middle Name:CLIFFORD
Last Name:NING
Suffix:JR
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 1:33424 DEEP FOREST RD
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-9736
Mailing Address - Country:US
Mailing Address - Phone:303-670-7171
Mailing Address - Fax:
Practice Address - Street 1:400 INDIANA ST
Practice Address - Street 2:SUITE 300
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-5027
Practice Address - Country:US
Practice Address - Phone:303-885-2550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO16283208800000X
VT042.0012859208800000X
CODR.0016283208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1022867Medicaid
VTY400137843OtherMEDICARE PTAN LINKED TO CVMC MPG
CO01162833Medicaid
VTY400137843OtherMEDICARE PTAN LINKED TO CVMC MPG
VT1022867Medicaid