Basic Information
Provider Information | |||||||||
NPI: | 1992167001 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CALIFF | ||||||||
FirstName: | THOMAS | ||||||||
MiddleName: | ALLEN | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 3699 | ||||||||
Address2: |   | ||||||||
City: | BRECKENRIDGE | ||||||||
State: | CO | ||||||||
PostalCode: | 804243699 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9193687046 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 340 PEAK ONE DRIVE | ||||||||
Address2: |   | ||||||||
City: | FRISCO | ||||||||
State: | CO | ||||||||
PostalCode: | 80443 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9706688123 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/28/2016 | ||||||||
LastUpdateDate: | 02/17/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 02/01/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | DR.0061456 | CO | Y |   | Allopathic & Osteopathic Physicians | Emergency Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 9000177410 | 05 | CO |   | MEDICAID | 029003 | 01 | CO | KAISER COMMERCIAL NUMBER | OTHER |