Provider Demographics
NPI:1770602013
Name:DOUGLAS FAMILY MEDICINE, P.C.
Entity type:Organization
Organization Name:DOUGLAS FAMILY MEDICINE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BELTON
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:HALLMARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-688-3434
Mailing Address - Street 1:1189 S PERRY ST STE 230
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-1959
Mailing Address - Country:US
Mailing Address - Phone:303-688-3434
Mailing Address - Fax:303-688-4454
Practice Address - Street 1:1189 S PERRY ST STE 230
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-1959
Practice Address - Country:US
Practice Address - Phone:303-688-3434
Practice Address - Fax:303-688-4454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO23157207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COB23268Medicare UPIN