Individual
TODD DEBOOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1950 MOUNTAIN VIEW AVE, LONGMONT, CO 80501-3129
(303) 776-4824
Mailing address
PO BOX 7328, LOVELAND, CO 80537-0328
(970) 663-2742
(970) 342-2093
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
37706
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
220026268
RAILROAD MEDICARE
CO
05
—
41207734
—
CO
Enumeration date
06/28/2006
Last updated
01/26/2021
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