Provider Demographics
NPI:1801855960
Name:MCCAULLEY, MARK E (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:E
Last Name:MCCAULLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 CENTRAL PARK DR
Mailing Address - Street 2:SUITE #100
Mailing Address - City:STEAMBOAT SPGS
Mailing Address - State:CO
Mailing Address - Zip Code:80487
Mailing Address - Country:US
Mailing Address - Phone:970-879-3327
Mailing Address - Fax:970-870-3499
Practice Address - Street 1:940 CENTRAL PARK DR
Practice Address - Street 2:SUITE #100
Practice Address - City:STEAMBOAT SPGS
Practice Address - State:CO
Practice Address - Zip Code:80487
Practice Address - Country:US
Practice Address - Phone:970-879-3327
Practice Address - Fax:970-870-3499
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO23289207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01232891Medicaid
CO110224255OtherRAILROAD MEDICARE
CO110224255OtherRAILROAD MEDICARE
COC394338Medicare PIN
E05630Medicare UPIN