Provider Demographics
NPI:1326038555
Name:DOUTHIT, MARK B (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:B
Last Name:DOUTHIT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2500 ROCKY MOUNTAIN AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9004
Mailing Address - Country:US
Mailing Address - Phone:970-624-1800
Mailing Address - Fax:970-624-1891
Practice Address - Street 1:2301 HOUSE AVE STE 301B
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-3176
Practice Address - Country:US
Practice Address - Phone:307-778-1849
Practice Address - Fax:307-778-4995
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO29696208600000X, 208G00000X
WY11195A208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01296961Medicaid
NE1326038555Medicaid
WY133577400Medicaid
COP00970361OtherRAILROAD MEDICARE PTAN
CO01296961Medicaid
COCOA102985Medicare PIN