Provider Demographics
NPI:1659445633
Name:CARLTON, JOHN WINSLOW (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:WINSLOW
Last Name:CARLTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SANDY
Other - Middle Name:
Other - Last Name:CARLTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1107 S. LEMAY AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-3955
Mailing Address - Country:US
Mailing Address - Phone:970-493-7442
Mailing Address - Fax:970-493-2900
Practice Address - Street 1:2695 ROCKY MOUNTAIN AVE.
Practice Address - Street 2:SUITE 200
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-9075
Practice Address - Country:US
Practice Address - Phone:970-493-7442
Practice Address - Fax:970-493-2990
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO19957174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01199579Medicaid
CO1659445633OtherNPI JOHN W CARLTON
COCF8618Medicare PIN
CO1659445633OtherNPI JOHN W CARLTON