Organization
FT LUPTON MEDICAL TEAM PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SELWYN MARTIN SPRAY MD (PRESIDENT)
(303) 857-1007
Entity
Organization
Contact information
Practice address
308 DENVER AVE, FORT LUPTON, CO 80621
(303) 857-1007
(303) 857-1227
Mailing address
308 DENVER AVE, FORT LUPTON, CO 80621-1822
(303) 857-1007
(303) 857-1227
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
17794
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04018990
—
CO
01
—
4009915
AETNA
CO
Enumeration date
10/19/2006
Last updated
06/27/2008
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