Basic Information
Provider Information
NPI: 1679743439
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ULDRICH
FirstName: TIMOTHY
MiddleName: JAMES
NamePrefix: MR.
NameSuffix:  
Credential: P.A.
OtherOrganizationName:  
OtherOrganizationType:  
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Mailing Information
Address1: 2695 ROCKY MOUNTAIN AVE STE 150
Address2:  
City: LOVELAND
State: CO
PostalCode: 805389071
CountryCode: US
TelephoneNumber: 9706242404
FaxNumber: 7207180993
Practice Location
Address1: 2315 E HARMONY RD STE 170
Address2:  
City: FORT COLLINS
State: CO
PostalCode: 805288620
CountryCode: US
TelephoneNumber: 9704958450
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/08/2008
LastUpdateDate: 06/17/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
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AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363AM0700X3743AZN Physician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
363A00000XPA.0005255COY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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