Provider Demographics
NPI:1275524647
Name:DENNIS, DOUGLAS ALAN (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:ALAN
Last Name:DENNIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2425 S COLORADO BLVD
Mailing Address - Street 2:STE 270
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-5946
Mailing Address - Country:US
Mailing Address - Phone:720-524-1367
Mailing Address - Fax:720-524-1422
Practice Address - Street 1:2425 S COLORADO BLVD
Practice Address - Street 2:STE 270
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-5946
Practice Address - Country:US
Practice Address - Phone:720-524-1367
Practice Address - Fax:720-524-1422
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2013-01-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO25884207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01258814Medicaid
COC02934Medicare UPIN
COC363488Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER #