Healthcare Provider Details

I. General information

NPI: 1033434980
Provider Name (Legal Business Name): AMANDA HOFFERT GILMARTIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA BIRD HOFFERT GILMARTIN MD

II. Dates (important events)

Enumeration Date: 04/05/2010
Last Update Date: 10/06/2021
Certification Date: 10/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 POTOMAC CIR
AURORA CO
80011-6714
US

IV. Provider business mailing address

PO BOX 110429
AURORA CO
80042-0429
US

V. Phone/Fax

Practice location:
  • Phone: 720-777-1234
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number10380A
License Number StateWY
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDR.0052186
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: