Basic Information
| Provider Information | |||||||||
| NPI: | 1093005738 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WAXWEILER | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | VICTOR | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 525 BOB PETERS GRV | ||||||||
| Address2: | 4080 BRIARGATE PARKWAY | ||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809500001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7193656800 | ||||||||
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| Practice Location | |||||||||
| Address1: | 525 BOB PETERS GRV | ||||||||
| Address2: | RADIATION ONCOLOGY | ||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809500001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7193656800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2011 | ||||||||
| LastUpdateDate: | 12/20/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | DR.0056707 | CO | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
No ID Information.