Healthcare Provider Details

I. General information

NPI: 1205928264
Provider Name (Legal Business Name): MARTIN MCDERMOTT MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 02/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 PARK AVE
FORT LUPTON CO
80621-1929
US

IV. Provider business mailing address

327 PARK AVE
FORT LUPTON CO
80621-1929
US

V. Phone/Fax

Practice location:
  • Phone: 303-857-2711
  • Fax: 303-857-1408
Mailing address:
  • Phone: 303-857-2711
  • Fax: 303-857-1408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARTIN DANIEL MCDERMOTT
Title or Position: OWNER
Credential: M.D.
Phone: 303-857-2711