MEDICARE: JAMIE JONATHAN DOUCET MD

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	207RC0000X	Cardiovascular Disease Physician	38570	CO
2	207RI0011X	Interventional Cardiology Physician	DR.0038570	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

General Provider Information

NPI Number	:	1417994385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE JONATHAN DOUCET MD

Provider Business Mailing Address
First Line	:	5450 WESTERN AVE
Second Line	:	SUITE B
City	:	BOULDER
State	:	CO
Zip	:	80301-2709
Country	:	US
Telephone Number	:	303-442-2395
Fax Number	:	303-442-1073

Provider Business Practice Location Address
First Line	:	4743 ARAPAHOE AVE
Second Line	:	SUITE 201
City	:	BOULDER
State	:	CO
Zip	:	80303-1113
Country	:	US
Telephone Number	:	303-442-2395
Fax Number	:	303-442-1073

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

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	03/17/2018

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