Healthcare Provider Details

I. General information

NPI: 1669456497
Provider Name (Legal Business Name): DOUGLAS W BEARD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 06/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 RIVERSIDE AVE
FORT COLLINS CO
80524-4352
US

IV. Provider business mailing address

1313 RIVERSIDE AVE
FORT COLLINS CO
80524-4352
US

V. Phone/Fax

Practice location:
  • Phone: 970-493-1292
  • Fax: 970-493-9066
Mailing address:
  • Phone: 970-493-1292
  • Fax: 970-493-9066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number31566
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number17861
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: