Provider Demographics
NPI:1861436503
Name:TARSHIS, GARY ANDREW (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:ANDREW
Last Name:TARSHIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2141 N ACADEMY CIRCLE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1672
Mailing Address - Country:US
Mailing Address - Phone:719-597-4200
Mailing Address - Fax:719-597-4495
Practice Address - Street 1:2141 N ACADEMY CIRCLE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1672
Practice Address - Country:US
Practice Address - Phone:719-597-4200
Practice Address - Fax:719-597-4495
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QU0200X
CO29971207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
A48741Medicare UPIN
454418Medicare ID - Type Unspecified