Provider Demographics
NPI:1982635181
Name:FITTS, DERRICK LORENZO SR (MA, AT, C, PES)
Entity Type:Individual
Prefix:MR
First Name:DERRICK
Middle Name:LORENZO
Last Name:FITTS
Suffix:SR
Gender:M
Credentials:MA, AT, C, PES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5337 S ROME CIR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80015-7515
Mailing Address - Country:US
Mailing Address - Phone:303-405-1320
Mailing Address - Fax:303-405-1120
Practice Address - Street 1:1000 CHOPPER CIR
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-5805
Practice Address - Country:US
Practice Address - Phone:303-405-1320
Practice Address - Fax:303-405-1120
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO977482174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist