Provider Demographics
NPI:1235115981
Name:HILL, DOUGLAS MELVIN
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:MELVIN
Last Name:HILL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:DOUGLAS
Other - Middle Name:M
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 173862
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80217-3862
Mailing Address - Country:US
Mailing Address - Phone:303-306-7783
Mailing Address - Fax:303-306-7753
Practice Address - Street 1:9191 GRANT ST.
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-8812
Practice Address - Country:US
Practice Address - Phone:303-450-4482
Practice Address - Fax:303-306-7753
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO18807207P00000X
WY7103A207P00000X
OH34002204207P00000X
CODR.0018807207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY605960009OtherFBL
CO01188077Medicaid
CO930039092OtherRAILROAD MEDICARE
WY314336OtherBSWY
WYP00308753Medicare PIN
CO930039092OtherRAILROAD MEDICARE
CO01188077Medicaid
COCE50013Medicare PIN