Healthcare Provider Details

I. General information

NPI: 1669932760
Provider Name (Legal Business Name): CMDPN MEDICAL GROUP OF NEW JERSEY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2019
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 LAWRENCE ST # 101
DENVER CO
80205-3422
US

IV. Provider business mailing address

3513 BRIGHTON BLVD STE 230
DENVER CO
80216-3606
US

V. Phone/Fax

Practice location:
  • Phone: 720-996-0522
  • Fax:
Mailing address:
  • Phone: 720-996-0522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN DUTTON
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 720-996-0522