1437130424 NPI number — TIMOTHY JOSEPH MAZZOLA M.D.

Employer Identification Number (EIN)	:
Provider Organization Name (Legal Business Name)	:
Provider Last Name (Legal Name)	:	MAZZOLA
Provider First Name	:	TIMOTHY
Provider Middle Name	:	JOSEPH
Provider Name Prefix Text	:
Provider Name Suffix Text	:
Provider Credential Text	:	M.D.
Provider Gender Code	:	M

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Provider Other First Name	:
Provider Other Middle Name	:
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Provider Other Name Suffix Text	:
Provider Other Credential Text	:
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NPI Number	:	1437130424
Entity Type Code	:	Individual
Replacement NPI	:
Last Update Date	:	10/29/2009
NPI Deactivation Reason Code	:
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Provider First Line Business Mailing Address	:	3550 LUTHERAN PKWY
Provider Second Line Business Mailing Address	:	SUITE 201
Provider Business Mailing Address City Name	:	WHEAT RIDGE
Provider Business Mailing Address State Name	:	CO
Provider Business Mailing Address Postal Code	:	800336017
Provider Business Mailing Address Country Code	:	US
Provider Business Mailing Address Telephone Number	:	3034566000
Provider Business Mailing Address Fax Number	:	3034202279

Provider First Line Business Practice Location Address	:	80 HEALTH PARK DR
Provider Second Line Business Practice Location Address	:	SUITE 230
Provider Business Practice Location Address City Name	:	LOUISVILLE
Provider Business Practice Location Address State Name	:	CO
Provider Business Practice Location Address Postal Code	:	800279584
Provider Business Practice Location Address Country Code	:	US
Provider Business Practice Location Address Telephone Number	:	3036652603
Provider Business Practice Location Address Fax Number	:	3036652605
Provider Enumeration Date	:	11/08/2005

Authorized Official Last Name	:
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• Taxonomy code: 207QS0010X , with the licence number:  41636 , registered in the state of CO .

• Identifier: 86956311 , issued by the state of ( CO ) . This identifiers is of the category "".
• Identifier: 809050 , issued by the state of ( CO ) . This identifiers is of the category "".
• Identifier: I59410 , issued by the state of ( CO ) . This identifiers is of the category "".