Healthcare Provider Details

I. General information

NPI: 1144252602
Provider Name (Legal Business Name): DOUGLAS MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 S WILCOX ST
CASTLE ROCK CO
80104-2662
US

IV. Provider business mailing address

410 S WILCOX ST
CASTLE ROCK CO
80104-2662
US

V. Phone/Fax

Practice location:
  • Phone: 303-688-6900
  • Fax: 303-688-1417
Mailing address:
  • Phone: 303-688-6900
  • Fax: 303-688-1417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number16446
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number16446
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number16446
License Number StateCO
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number16446
License Number StateCO

VIII. Authorized Official

Name: MS. MARY K ENGLAND
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 303-688-6900