MEDICARE: TAYLOR DOUTHITT

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	363A00000X	Physician Assistant
2	363A00000X	Physician Assistant	0005736	CO

General Provider Information

NPI Number	:	1134771850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR DOUTHITT

Provider Business Mailing Address
First Line	:	845 CLERMONT ST APT 217
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80220-3817
Country	:	US
Telephone Number	:	727-410-2432
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 E 1ST AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80206-5638
Country	:	US
Telephone Number	:	303-538-5800
Fax Number	:

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

Provider Enumeration Date	:	07/12/2019
Last Update Date	:	01/04/2020

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Directions to “ TAYLOR DOUTHITT ” Practice Location

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