Individual
DR. MARK B DOUTHIT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2301 HOUSE AVE STE 301B, CHEYENNE, WY 82001-3176
(307) 778-1849
(307) 778-4995
Mailing address
2500 ROCKY MOUNTAIN AVE, SUITE 100, LOVELAND, CO 80538-9004
(970) 624-1800
(970) 624-1891
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
29696
CO
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
11195A
WY
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
29696
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01296961
—
CO
05
—
1326038555
—
NE
05
—
133577400
—
WY
01
—
P00970361
RAILROAD MEDICARE PTAN
CO
Enumeration date
10/27/2005
Last updated
04/05/2021
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