MEDICARE: DOUGLAS BRUCE DEYOUNG DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	27536	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	DE27536	OTHER	CO	BCBS

General Provider Information

NPI Number	:	1811989064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS BRUCE DEYOUNG DO

Provider Business Mailing Address
First Line	:	4674 SNOW MESA DR
Second Line	:	STE 140
City	:	FORT COLLINS
State	:	CO
Zip	:	80528-8615
Country	:	US
Telephone Number	:	970-225-5043
Fax Number	:	970-482-9646

Provider Business Practice Location Address
First Line	:	313 W DRAKE RD
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-2846
Country	:	US
Telephone Number	:	970-482-8881
Fax Number	:	970-482-9646

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	11/18/2015

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