Healthcare Provider Details

I. General information

NPI: 1982635181
Provider Name (Legal Business Name): DERRICK LORENZO FITTS SR. M.A., A.T., C., PES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 CHOPPER CIR
DENVER CO
80204-5805
US

IV. Provider business mailing address

5337 S ROME CIR
AURORA CO
80015-7515
US

V. Phone/Fax

Practice location:
  • Phone: 303-405-1320
  • Fax: 303-405-1120
Mailing address:
  • Phone: 303-405-1320
  • Fax: 303-405-1120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number977482
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: