Provider Demographics
NPI:1801971098
Name:MARTIN-WIMMER, DARNELL L (MD)
Entity type:Individual
Prefix:
First Name:DARNELL
Middle Name:L
Last Name:MARTIN-WIMMER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7275 WEST VASSAR AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80227
Mailing Address - Country:US
Mailing Address - Phone:303-914-0341
Mailing Address - Fax:303-935-5095
Practice Address - Street 1:1785 KIPLING
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215
Practice Address - Country:US
Practice Address - Phone:303-935-4681
Practice Address - Fax:303-935-5095
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO30990207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC442048Medicare PIN