Provider Demographics
NPI:1851341465
Name:MARTY, TERRI LOUISE (MD)
Entity Type:Individual
Prefix:DR
First Name:TERRI
Middle Name:LOUISE
Last Name:MARTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2121 E HARMONY RD
Mailing Address - Street 2:STE 330
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-3400
Mailing Address - Country:US
Mailing Address - Phone:970-221-5878
Mailing Address - Fax:970-221-3564
Practice Address - Street 1:2121 E HARMONY RD
Practice Address - Street 2:STE 330
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-3400
Practice Address - Country:US
Practice Address - Phone:970-221-5878
Practice Address - Fax:970-221-3564
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2014-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO45632208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
COP00801697OtherRAILROAD MEDICARE
CO48776742Medicaid
MN870827400Medicaid
MNG25552Medicare UPIN
COCOA102981Medicare PIN
MN02001784Medicare ID - Type Unspecified