Healthcare Provider Details

I. General information

NPI: 1881864072
Provider Name (Legal Business Name): TODD DEXTRADEUR MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2008
Last Update Date: 10/09/2020
Certification Date: 10/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 W. 84TH AVE STE 300
THORNTON CO
80260-4883
US

IV. Provider business mailing address

1324 S. RACE STREET
DENVER CO
80210-2332
US

V. Phone/Fax

Practice location:
  • Phone: 720-289-8184
  • Fax: 303-457-2341
Mailing address:
  • Phone: 720-289-8184
  • Fax: 303-457-2341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number35500
License Number StateCO

VIII. Authorized Official

Name: TODD C. DEXTRADEUR
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 720-289-8184