Provider Demographics
NPI:1114137577
Name:FORTE, MARK DOUGLAS (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:DOUGLAS
Last Name:FORTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:8683 E LINCOLN AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-9811
Mailing Address - Country:US
Mailing Address - Phone:303-706-1555
Mailing Address - Fax:303-706-1199
Practice Address - Street 1:8683 E LINCOLN AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-9811
Practice Address - Country:US
Practice Address - Phone:303-706-1555
Practice Address - Fax:303-706-1199
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO290252085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology