Healthcare Provider Details

I. General information

NPI: 1538262589
Provider Name (Legal Business Name): JOSEPH L MARTINDALE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 02/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8931 HURON ST
THORNTON CO
80260-6806
US

IV. Provider business mailing address

3898 BIRCHWOOD DR
BOULDER CO
80304-1419
US

V. Phone/Fax

Practice location:
  • Phone: 303-853-3654
  • Fax: 303-853-3656
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number48367
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier807512400
Identifier TypeMEDICAID
Identifier StateID
Identifier Issuer
# 2
Identifier000010157051
Identifier TypeOTHER
Identifier StateID
Identifier IssuerREGENCE BLUE SHIELD
# 3
IdentifierS6023
Identifier TypeOTHER
Identifier StateID
Identifier IssuerBLUE CROSS OF IDAHO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: