Healthcare Provider Details

I. General information

NPI: 1144275405
Provider Name (Legal Business Name): DAVID L LENDERTS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 04/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19021 US HIGHWAY 285 CONEJOS COUNTY HOSPITAL
LA JARA CO
81140
US

IV. Provider business mailing address

709 WEBER DRIVE
ALAMOSA CO
81101-2046
US

V. Phone/Fax

Practice location:
  • Phone: 719-274-5121
  • Fax:
Mailing address:
  • Phone: 719-589-5719
  • Fax: 719-587-9865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number22476
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: