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General NPI Number Information
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NPI Number | 1326038555
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Entity Type | Individual
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Provider Name | MARK B DOUTHIT MD
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Gender | Male
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Dates
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Enumeration Date | 10/27/2005
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Last Update Date | 04/05/2021
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Provider Practice Location Address
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Address Line | 2301 HOUSE AVE STE 301B
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City | CHEYENNE
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State | WY
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Zip | 82001-3176
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Country | US
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Telephone | 307-778-1849
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Fax | 307-778-4995
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Provider Business Mailing Address
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Address Line | 2500 ROCKY MOUNTAIN AVE SUITE 100
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City | LOVELAND
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State | CO
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Zip | 80538-9004
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Country | US
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Telephone | 970-624-1800
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Fax | 970-624-1891
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 29696
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 29696
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 11195A
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License Number State | WY
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