Provider Demographics
NPI:1992984025
Name:MCCOLLUM, TIMOTHY JOHN (PA-C)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:JOHN
Last Name:MCCOLLUM
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7261 S BROADWAY STE 103
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80122-8018
Mailing Address - Country:US
Mailing Address - Phone:303-358-5130
Mailing Address - Fax:720-510-2704
Practice Address - Street 1:7261 S BROADWAY STE 103
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80122-8018
Practice Address - Country:US
Practice Address - Phone:303-358-5130
Practice Address - Fax:720-510-2704
Is Sole Proprietor?:No
Enumeration Date:2007-10-25
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1684363AS0400X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO90694Medicare UPIN