Organization
CENTRAL COLORADO DERMATOLOGY, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANTHONY LOUIS TIMKO (PRESIDENT)
(719) 539-4600
Entity
Organization
Contact information
Practice address
925 RUSH DR, SALIDA, CO 81201-9665
(719) 539-4600
(719) 539-4629
Mailing address
PO BOX 849, SALIDA, CO 81201-0849
(719) 539-4600
(719) 539-4629
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
39785
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
35180846
—
CO
Enumeration date
03/18/2008
Last updated
02/07/2011
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