Provider Demographics
NPI:1992741839
Name:WIRT, TIMOTHY CRAIG (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:CRAIG
Last Name:WIRT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1313 RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-4352
Mailing Address - Country:US
Mailing Address - Phone:970-493-1292
Mailing Address - Fax:970-493-1210
Practice Address - Street 1:1313 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-4352
Practice Address - Country:US
Practice Address - Phone:970-493-1292
Practice Address - Fax:970-493-1210
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO23076207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
COD24208Medicare UPIN