Healthcare Provider Details

I. General information

NPI: 1689170169
Provider Name (Legal Business Name): MARTIN JOHN AHERN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2018
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 W 24TH ST
PUEBLO CO
81003-1411
US

IV. Provider business mailing address

PO BOX 1108
SALIDA CO
81201-1108
US

V. Phone/Fax

Practice location:
  • Phone: 719-546-4000
  • Fax:
Mailing address:
  • Phone: 603-370-7977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License NumberDR0068400
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberDR0068400
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: