Provider Demographics
NPI:1003879297
Name:MARTZ, GARY LEE (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:LEE
Last Name:MARTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1721 E 19TH AVE
Mailing Address - Street 2:SUITE 528
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1251
Mailing Address - Country:US
Mailing Address - Phone:303-813-1400
Mailing Address - Fax:303-813-1401
Practice Address - Street 1:1721 E 19TH AVE
Practice Address - Street 2:SUITE 528
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1251
Practice Address - Country:US
Practice Address - Phone:303-813-1400
Practice Address - Fax:303-813-1401
Is Sole Proprietor?:No
Enumeration Date:2006-04-09
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO254652084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
COE65649Medicare UPIN
COC5831-1Medicare ID - Type Unspecified