MEDICARE: GARY LEE MARTZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	25465	CO

General Provider Information

NPI Number	:	1003879297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY LEE MARTZ M.D.

Provider Business Mailing Address
First Line	:	1721 E 19TH AVE
Second Line	:	SUITE 528
City	:	DENVER
State	:	CO
Zip	:	80218-1251
Country	:	US
Telephone Number	:	303-813-1400
Fax Number	:	303-813-1401

Provider Business Practice Location Address
First Line	:	1721 E 19TH AVE
Second Line	:	SUITE 528
City	:	DENVER
State	:	CO
Zip	:	80218-1251
Country	:	US
Telephone Number	:	303-813-1400
Fax Number	:	303-813-1401

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2006
Last Update Date	:	12/19/2008

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