MEDICARE: MR. DERRICK LORENZO FITTS SR. M.A., A.T., C., PES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	977482	CO

General Provider Information

NPI Number	:	1982635181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DERRICK LORENZO FITTS SR. M.A., A.T., C., PES

Provider Business Mailing Address
First Line	:	5337 S ROME CIR
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80015-7515
Country	:	US
Telephone Number	:	303-405-1320
Fax Number	:	303-405-1120

Provider Business Practice Location Address
First Line	:	1000 CHOPPER CIR
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80204-5805
Country	:	US
Telephone Number	:	303-405-1320
Fax Number	:	303-405-1120

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	07/08/2007

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