Basic Information
| Provider Information | |||||||||
| NPI: | 1871865972 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GEORGE | ||||||||
| FirstName: | TOBIAS | ||||||||
| MiddleName: | JOHN CRANDALL | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | ACNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15 W DRY CREEK CIR | ||||||||
| Address2: | |||||||||
| City: | LITTLETON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801204427 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3039521100 | ||||||||
| FaxNumber: | 3039528185 | ||||||||
| Practice Location | |||||||||
| Address1: | 777 BANNOCK ST | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802044507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036021460 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2012 | ||||||||
| LastUpdateDate: | 04/11/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | 990306 | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
ID Information
| ID | Type | State | Issuer | Description | 60288566 | 05 | CO | MEDICAID |