Individual
TIMOTHY A MACKIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
13631 COLORADO BLVD, THORNTON, CO 80602-7051
(303) 252-2960
(303) 252-2964
Mailing address
2695 ROCKY MOUNTAIN AVE STE 150, LOVELAND, CO 80538-9071
(970) 624-4451
(970) 490-4199
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
1718
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
019498
KAISER COMMERCIAL NUMBER
CO
05
—
12839701
—
CO
Enumeration date
11/09/2005
Last updated
11/03/2021
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