Healthcare Provider Details

I. General information

NPI: 1831193630
Provider Name (Legal Business Name): DAVID E MCCARTY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 11/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4895 RIVERBEND RD
BOULDER CO
80301-2640
US

IV. Provider business mailing address

4895 RIVERBEND RD
BOULDER CO
80301-2640
US

V. Phone/Fax

Practice location:
  • Phone: 720-279-9098
  • Fax: 720-540-4250
Mailing address:
  • Phone: 720-279-9098
  • Fax: 720-540-4250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberDR.0054680
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1147362
Identifier TypeMEDICAID
Identifier StateLA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: