Healthcare Provider Details

I. General information

NPI: 1659445633
Provider Name (Legal Business Name): JOHN WINSLOW CARLTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SANDY CARLTON M.D.

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 08/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2695 ROCKY MOUNTAIN AVE. SUITE 200
LOVELAND CO
80538-9075
US

IV. Provider business mailing address

1107 S. LEMAY AVE SUITE 300
FORT COLLINS CO
80524-3955
US

V. Phone/Fax

Practice location:
  • Phone: 970-493-7442
  • Fax: 970-493-2990
Mailing address:
  • Phone: 970-493-7442
  • Fax: 970-493-2900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number19957
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: