Provider Demographics
NPI:1073734240
Name:DOUTHIT FAMILY MEDICINE
Entity Type:Organization
Organization Name:DOUTHIT FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:DOUTHIT
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:303-451-8069
Mailing Address - Street 1:1930 SO FEDERAL BLVD
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80219
Mailing Address - Country:US
Mailing Address - Phone:303-933-9142
Mailing Address - Fax:303-934-7332
Practice Address - Street 1:9981 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229
Practice Address - Country:US
Practice Address - Phone:303-451-8069
Practice Address - Fax:303-450-2372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO40585743Medicaid
COC805057Medicare ID - Type Unspecified