Individual
THOMAS J LALLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10900 W 44TH AVE UNIT 200, SUITE 202, WHEAT RIDGE, CO 80033-2742
(303) 379-9371
(303) 284-4082
Mailing address
10900 W 44TH AVE UNIT 200, SUITE 202, WHEAT RIDGE, CO 80033-2742
(303) 379-9371
(303) 284-4082
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
41971
CO
207R00000X
Internal Medicine Physician
Primary
DR.0041971
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
16108272
—
CO
01
—
C526618
MEDICARE PTAN
CO
Enumeration date
02/27/2006
Last updated
11/22/2017
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