Provider Demographics
NPI:1003889353
Name:LOURY, MARK CAMDEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:CAMDEN
Last Name:LOURY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2001 S SHIELDS ST STE E101
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-1872
Mailing Address - Country:US
Mailing Address - Phone:970-493-5334
Mailing Address - Fax:970-472-0638
Practice Address - Street 1:2001 S SHIELDS ST STE E101
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-1872
Practice Address - Country:US
Practice Address - Phone:970-493-5334
Practice Address - Fax:970-493-3727
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO33274207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01332741Medicaid
CO040007458OtherRAILROAD MEDICARE
CO01332741Medicaid
CO040007458OtherRAILROAD MEDICARE