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General NPI Number Information
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NPI Number | 1942382023
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Entity Type | Organization
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Legal Business Name | FT LUPTON MEDICAL TEAM PC
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Dates
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Enumeration Date | 10/19/2006
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Last Update Date | 06/27/2008
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Provider Practice Location Address
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Address Line | 308 DENVER AVE
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City | FORT LUPTON
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State | CO
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Zip | 80621
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Country | US
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Telephone | 303-857-1007
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Fax | 303-857-1227
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Provider Business Mailing Address
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Address Line | 308 DENVER AVE
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City | FORT LUPTON
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State | CO
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Zip | 80621-1822
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Country | US
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Telephone | 303-857-1007
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Fax | 303-857-1227
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Authorized Official
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Title or Position | PRESIDENT
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Name | SELWYN MARTIN SPRAY
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Credential | MD
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Telephone | 303-857-1007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 17794
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License Number State | CO
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