Individual
IVOR S DOUGLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
777 BANNOCK ST, MC 7782, DENVER, CO 80204-4507
(303) 436-6000
Mailing address
777 BANNOCK ST, MC 7782, DENVER, CO 80204-4507
(303) 436-6000
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
41063
CO
207RP1001X
Pulmonary Disease Physician
41063
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
16828534
—
CO
01
—
P00128141
RAILROAD MEDICARE
CO
Enumeration date
07/26/2006
Last updated
03/02/2021
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