Provider Demographics
NPI:1538262589
Name:MARTINDALE, JOSEPH L (DO)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:L
Last Name:MARTINDALE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3898 BIRCHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-1419
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8931 HURON ST
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80260-6806
Practice Address - Country:US
Practice Address - Phone:303-853-3654
Practice Address - Fax:303-853-3656
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO483672084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807512400Medicaid
ID000010157051OtherREGENCE BLUE SHIELD
IDS6023OtherBLUE CROSS OF IDAHO
ID000010157051OtherREGENCE BLUE SHIELD