Healthcare Provider Details

I. General information

NPI: 1841261385
Provider Name (Legal Business Name): ROBERT A. MCDERMOTT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 04/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 MIDLAND AVENUE SUITE #230
GLENWOOD SPRINGS CO
81601-9800
US

IV. Provider business mailing address

PO BOX #2601
GLENWOOD SPRINGS CO
81602-2601
US

V. Phone/Fax

Practice location:
  • Phone: 970-947-0600
  • Fax: 970-947-0601
Mailing address:
  • Phone: 970-947-0600
  • Fax: 970-947-0601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberDR.0041037
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: