MEDICARE: DR. BELTON DOUGLAS HALLMARK M.D.

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	23157	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	G0423	OTHER	TX	TEXAS LICENSE

General Provider Information

NPI Number	:	1225018633
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BELTON DOUGLAS HALLMARK M.D.

Provider Business Mailing Address
First Line	:	PO BOX 17837
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-4073
Country	:	US
Telephone Number	:	303-688-3434
Fax Number	:	303-688-4454

Provider Business Practice Location Address
First Line	:	1189 S PERRY ST STE 230
Second Line	:
City	:	CASTLE ROCK
State	:	CO
Zip	:	80104-1959
Country	:	US
Telephone Number	:	303-688-3434
Fax Number	:	303-688-4454

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

Provider Enumeration Date	:	01/20/2006
Last Update Date	:	07/11/2023

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